Healthcare Provider Details

I. General information

NPI: 1407821036
Provider Name (Legal Business Name): MICHAEL SCANLON NP, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CRAWFORD ST.
LITTLETON NH
03561
US

IV. Provider business mailing address

21 CRAWFORD ST. PO BOX 905
LITTLETON NH
03561
US

V. Phone/Fax

Practice location:
  • Phone: 603-236-9230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number054066-23-03
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: