Healthcare Provider Details

I. General information

NPI: 1114890266
Provider Name (Legal Business Name): DAVID SCOTT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 ATLANTIC AVE
ATLANTIC CITY NJ
08401-6080
US

IV. Provider business mailing address

3830 ATLANTIC AVE
ATLANTIC CITY NJ
08401-6080
US

V. Phone/Fax

Practice location:
  • Phone: 609-449-4343
  • Fax: 609-594-8701
Mailing address:
  • Phone: 609-449-4343
  • Fax: 609-594-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00969900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: