Healthcare Provider Details

I. General information

NPI: 1609816768
Provider Name (Legal Business Name): STACY DENISE SCOTT-MCKINNEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13900 LAUREL LAKES AVENUE SUITE 240
LAUREL MD
20707-5046
US

IV. Provider business mailing address

13900 LAUREL LAKES AVENUE SUITE 240
LAUREL MD
20707-5046
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-1900
  • Fax: 301-497-9885
Mailing address:
  • Phone: 301-498-1900
  • Fax: 301-497-9885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0041884
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier199411500
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: