Healthcare Provider Details

I. General information

NPI: 1760507925
Provider Name (Legal Business Name): NICHOLAS G SCOTTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W PRATT ST
BALTIMORE MD
21223-2679
US

IV. Provider business mailing address

1001 W PRATT ST
BALTIMORE MD
21223-2679
US

V. Phone/Fax

Practice location:
  • Phone: 410-962-7190
  • Fax: 410-962-7194
Mailing address:
  • Phone: 410-962-7190
  • Fax: 410-962-7194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberD0043246
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: