=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417977067
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOT C REMICK MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2006
-----------------------------------------------------
Last Update Date | 04/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 CAMPUS DR SUITE 121
-----------------------------------------------------
City | SCARBOROUGH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04074-7171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-396-7760
-----------------------------------------------------
Fax | 207-396-8500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 RIVERSIDE ST SUITE 6B
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04103-1073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-661-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 35-071269
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | MD20833
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------