Healthcare Provider Details

I. General information

NPI: 1992123251
Provider Name (Legal Business Name): JOHN SCOTT PERSING M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 03/07/2021
Certification Date: 03/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 WESTERN AVE # 100
SOUTH PORTLAND ME
04106-2496
US

IV. Provider business mailing address

37 CHESTERFIELD RD
WETHERSFIELD CT
06109-3110
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-3446
  • Fax:
Mailing address:
  • Phone: 203-430-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD24618
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: