Scott Clough, MD
Individual provider Active NPI Pediatrics Physician · Bangor, ME
NPI 1821043068 · NPPES record last updated Mar 11, 2022
Key facts
- NPI
- 1821043068
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 015251 (ME)
- Practice address
- 133 Corporate Dr
Bangor, ME 04401-4312 - Phone
- (207) 941-1155
- Fax
- (207) 945-5063
- NPI assigned
- May 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040210000302 | ME | Practitioner - Pediatric Medicine | 1951295179 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015251 | ME | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern Maine Medical Center | Current |
Accepting new patients | |
| Eastern Maine Medical Center | Current |
Accepting new patients |
Locations
489 State St
Bangor, ME 04401
Phone (207) 973-8837
931 Union St
Fl 3
Bangor, ME 04401
489 State St
Ste A
Bangor, ME 04401
133 Corporate Dr
Bangor, ME 04401
Phone (207) 941-1155
43 Whiting Hill Rd
Ste 300
Brewer, ME 04412
Phone (207) 973-5000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 015251 | ME | Yes |
Addresses
Primary practice location
133 Corporate Dr
Bangor, ME 04401-4312
Mailing address
43 Whiting Hill Rd
Suite 300
Brewer, ME 04412-1005
Phone (207) 973-5000
Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.