Healthcare Provider Details

I. General information

NPI: 1548242100
Provider Name (Legal Business Name): KIRBY J SCOTT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 DUAL HWY SUITE #303
HAGERSTOWN MD
21740-6602
US

IV. Provider business mailing address

1800 DUAL HWY SUITE #303
HAGERSTOWN MD
21740-6602
US

V. Phone/Fax

Practice location:
  • Phone: 301-739-0400
  • Fax: 301-739-0402
Mailing address:
  • Phone: 301-739-0400
  • Fax: 301-739-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOS-008770-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0102050002
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberH0064647
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: