Healthcare Provider Details

I. General information

NPI: 1619970464
Provider Name (Legal Business Name): CAROL MARIE SCOTT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BELLONA LN SUITE 201
BALTIMORE MD
21204-2055
US

IV. Provider business mailing address

8415 BELLONA LN SUITE 201
BALTIMORE MD
21204-2055
US

V. Phone/Fax

Practice location:
  • Phone: 410-821-7775
  • Fax: 410-821-1320
Mailing address:
  • Phone: 410-821-7775
  • Fax: 410-821-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0003950
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: