Healthcare Provider Details

I. General information

NPI: 1164816138
Provider Name (Legal Business Name): SUSAN C SCOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 ORLEANS ST # 1189
BALTIMORE MD
21287-0013
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-614-2491
  • Fax:
Mailing address:
  • Phone: 410-933-1340
  • Fax: 202-660-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD0089223
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.134542
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD210001524
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: