Provider Demographics
NPI:1306054416
Name:OAKLEY, MICHAEL SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:OAKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-3336
Mailing Address - Country:US
Mailing Address - Phone:631-204-1361
Mailing Address - Fax:631-204-1367
Practice Address - Street 1:60 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-3336
Practice Address - Country:US
Practice Address - Phone:631-204-1361
Practice Address - Fax:631-204-1367
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY798781Medicare ID - Type Unspecified
NYA400046148Medicare PIN
NYF43678Medicare UPIN