Healthcare Provider Details

I. General information

NPI: 1245218163
Provider Name (Legal Business Name): DIANA L SCOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MADISON AVE FL 2
MOUNT HOLLY NJ
08060-2099
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 609-914-6198
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number25MA06948700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD445967
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA06948700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: