Healthcare Provider Details

I. General information

NPI: 1497741631
Provider Name (Legal Business Name): DEBORAH JL SCOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH JO LONG SCOTT MD

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S MAIN ST
WOLFEBORO NH
03894-4411
US

IV. Provider business mailing address

74 PLEASANT STREET STE 204
NEW LONDON NH
03257
US

V. Phone/Fax

Practice location:
  • Phone: 603-515-2093
  • Fax: 603-515-2031
Mailing address:
  • Phone: 603-526-4635
  • Fax: 603-526-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042-0008564
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8764
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: