Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 168980 | NY |
N | 111NI0900X | Internist | 168980 | NY |
Y | 207R00000X | Internist | MD21516 | ME |
Y | 111NI0900X | Internist | MD21516 | ME |
N | 208000000X | Pediatrician | 168980 | NY |
N | 208000000X | Pediatrician | MD21516 | ME |
NPI | 1003897935 |
---|---|
Provider Name | Anna Marie Scopellito-Olsen |
First Address | Staten Island, NY 10308-2918 |
Second Address | Sanford, ME 04073-2642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E04020 | (02) | NY |