Healthcare Provider Details

I. General information

NPI: 1679690663
Provider Name (Legal Business Name): CORIDALIA WALD SCOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CORIDALIA WALD-SCOTT MD

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 REVOLUTION MILL DR
GREENSBORO NC
27405-5067
US

IV. Provider business mailing address

PO BOX 13029
GREENSBORO NC
27415-3029
US

V. Phone/Fax

Practice location:
  • Phone: 336-510-1120
  • Fax: 336-510-1159
Mailing address:
  • Phone: 336-510-1120
  • Fax: 336-510-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number22318
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number22318
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: