Basic Information
| Provider Information | |||||||||
| NPI: | 1003897935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOPELLITO-OLSEN | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 96 MIDLAND RD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103082918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186686963 | ||||||||
| FaxNumber: | 7183512147 | ||||||||
| Practice Location | |||||||||
| Address1: | 25A JUNE ST STE 111 | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040732642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074907998 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 04/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 168980 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | MD21516 | ME | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 168980 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | MD21516 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.