Provider Demographics
NPI:1366447401
Name:AKIN, SCOTT G (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:G
Last Name:AKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 GANNETT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3266
Mailing Address - Country:US
Mailing Address - Phone:072-482-7800
Mailing Address - Fax:207-348-2178
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-4735
Practice Address - Fax:207-662-6388
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD287772085R0202X
IN01086974A2085R0202X
CO00570792085R0202X
AZ649892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0057079OtherSTATE LICENSE
ME1366447401Medicaid
IAMD-45451OtherSTATE LICENSE
IN01086974AOtherSTATE LICENSE
NE30739OtherSTATE LICENSE
AL515-15279OtherBLUE CROSS
AL051525197OtherBLUE CROSS
AL009938664Medicaid
AL051515278OtherBLUE CROSS
AL051515280OtherBLUE CROSS
AL009938662Medicaid
AL009984405Medicaid
AL051515270OtherBLUE CROSS
AL051515271OtherBLUE CROSS
AL051539831OtherBLUE CROSS
AL009938663Medicaid
AL009984405Medicaid
AL051515270OtherBLUE CROSS
AL051515271OtherBLUE CROSS
AL051539831OtherBLUE CROSS
AL7438624OtherAETNA
AL515-15279OtherBLUE CROSS
AL009938668Medicaid
AL051554739Medicare PIN