Healthcare Provider Details

I. General information

NPI: 1174960306
Provider Name (Legal Business Name): JEFFREY F SCOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFFREY F SCOTT MD

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 JOSEPH SIEWICK DR STE 402
FAIRFAX VA
22033-1745
US

IV. Provider business mailing address

3700 JOSEPH SIEWICK DR STE 402
FAIRFAX VA
22033-1745
US

V. Phone/Fax

Practice location:
  • Phone: 703-620-8900
  • Fax: 703-620-2288
Mailing address:
  • Phone: 703-620-8900
  • Fax: 703-620-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberD87221
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number0101277530
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: