Healthcare Provider Details

I. General information

NPI: 1376506345
Provider Name (Legal Business Name): SCOTT W. NUTTER, DPM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 BALTIMORE AVE
LAUREL MD
20707-5000
US

IV. Provider business mailing address

13950 BALTIMORE AVE
LAUREL MD
20707-5000
US

V. Phone/Fax

Practice location:
  • Phone: 301-317-6800
  • Fax: 301-317-4183
Mailing address:
  • Phone: 301-317-6800
  • Fax: 301-317-4183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP14048
License Number StateMD

VIII. Authorized Official

Name: DR. SCOTT W NUTTER
Title or Position: PRESIDENT
Credential: D.P.M., P.A.
Phone: 301-317-6800