Healthcare Provider Details

I. General information

NPI: 1023515467
Provider Name (Legal Business Name): SCOTT MUFFLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 10/22/2024
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DISCOVERY DRIVE
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

501 DISCOVERY DRIVE
CHESAPEAKE VA
23320
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-5145
  • Fax: 757-436-2480
Mailing address:
  • Phone: 757-547-5145
  • Fax: 757-436-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR-11148
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101279034
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: