Healthcare Provider Details

I. General information

NPI: 1346290889
Provider Name (Legal Business Name): MARK J SCOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE SUITE 401
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2123 AUBURN AVE SUITE 401
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-241-5489
  • Fax: 513-241-5490
Mailing address:
  • Phone: 513-241-5489
  • Fax: 513-241-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35.063315S
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.063315S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: