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Kenneth A Ault, MD

Individual provider Active NPI Hematology (Internal Medicine) Physician · Scarborough, ME

NPI 1477598688 · NPPES record last updated Jan 29, 2008

Key facts

NPI
1477598688
Entity type
Individual (NPI type 1)
Primary specialty
Hematology (Internal Medicine) Physician 207RH0000X
License
012169 (ME)
Practice address
81 Research Dr
Scarborough, ME 04074-7204
Phone
(207) 885-8130
Fax
(207) 885-8110
NPI assigned
Jun 19, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

  • Nordx Clinical Medical Laboratory · Scarborough, ME · NPI 1265671515
    NPD (past)

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
012169MEMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nordx Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 012169 ME
Hematology (Internal Medicine) Physician 207RH0000X 012169 ME Yes

Addresses

Primary practice location

81 Research Dr
Scarborough, ME 04074-7204

Mailing address

39 Wallace Ave
South Portland, ME 04106-6143
Phone (207) 523-3289

Other identifiers

IdentifierTypeStateIssuer
30201824MedicaidNH

Other providers in Scarborough, ME

All providers in Scarborough, ME · Hematology (Internal Medicine) Physician in Maine

Sources for this page

Verify at the official NPI Registry.