Healthcare Provider Details

I. General information

NPI: 1689727141
Provider Name (Legal Business Name): KAREN J SCOTT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 DEFENSE HWY STE 210
ANNAPOLIS MD
21401-7071
US

IV. Provider business mailing address

122 DEFENSE HWY STE 210
ANNAPOLIS MD
21401-7071
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-9694
  • Fax: 410-266-9695
Mailing address:
  • Phone: 410-266-9694
  • Fax: 410-266-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002051
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0002828
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: