Healthcare Provider Details

I. General information

NPI: 1275847022
Provider Name (Legal Business Name): EILEEN M SCOTT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILEEN M EDEN

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BURNETTS WAY STE. 100
SUFFOLK VA
23434-8168
US

IV. Provider business mailing address

PO BOX 7776
LANCASTER PA
17604-7776
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-5145
  • Fax:
Mailing address:
  • Phone: 888-985-2727
  • Fax: 856-779-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110003325
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA059265
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: