Healthcare Provider Details

I. General information

NPI: 1285749093
Provider Name (Legal Business Name): REGIONAL MEDICAL PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N. MAIN ST.
CORTLAND NY
13045
US

IV. Provider business mailing address

PO BOX 627 134 HOMER AVE.
CORTLAND NY
13045
US

V. Phone/Fax

Practice location:
  • Phone: 607-758-8019
  • Fax: 607-758-8210
Mailing address:
  • Phone: 607-758-8019
  • Fax: 607-758-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number196572
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number253350
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number145322-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number153402
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number134918
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number123597
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number211879
License Number StateNY

VIII. Authorized Official

Name: DR. ROGER E. SCOTT
Title or Position: PRESIDENT
Credential: D.O.
Phone: 607-758-8019