Healthcare Provider Details

I. General information

NPI: 1124212212
Provider Name (Legal Business Name): SCOTT RANDALL SCRAPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE N343 DOAN
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

700 ACKERMAN RD STE 570
COLUMBUS OH
43202-1579
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-1579
  • Fax: 614-293-4567
Mailing address:
  • Phone: 614-366-1579
  • Fax: 614-293-4567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number35093837
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35093837
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: