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Individual

BENJAMIN JACOB SCOLL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
195 FORE RIVER PKWY, SUITE 310, PORTLAND, ME 04102-2780
(207) 523-5901
(207) 523-5902
Mailing address
195 FORE RIVER PKWY, SUITE 310, PORTLAND, ME 04102-2780
(207) 523-5901
(207) 523-5902

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
018411
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1174762116
ME
Enumeration date
02/16/2009
Last updated
12/05/2011
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