Healthcare Provider Details

I. General information

NPI: 1003625765
Provider Name (Legal Business Name): SCOTT FIDDLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 PURPLE MARTIN CT
WILMINGTON NC
28411-8323
US

IV. Provider business mailing address

6420 PURPLE MARTIN CT
WILMINGTON NC
28411-8323
US

V. Phone/Fax

Practice location:
  • Phone: 910-660-3138
  • Fax:
Mailing address:
  • Phone: 910-660-3138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: