Healthcare Provider Details

I. General information

NPI: 1255371605
Provider Name (Legal Business Name): SCOTT JEFFREY DENARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 ALLEN ST STE 101
TROY NC
27371-2861
US

IV. Provider business mailing address

522 ALLEN ST SUITE 101
TROY NC
27371-2861
US

V. Phone/Fax

Practice location:
  • Phone: 910-571-5510
  • Fax:
Mailing address:
  • Phone: 910-571-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME98342
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number9300079
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: