Healthcare Provider Details

I. General information

NPI: 1861309148
Provider Name (Legal Business Name): MICHAEL H SCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4897 BENNETTS PASTURE RD UNIT 5354
SUFFOLK VA
23435-1362
US

IV. Provider business mailing address

220 DIAMOND AVE
CHESAPEAKE VA
23323-3007
US

V. Phone/Fax

Practice location:
  • Phone: 757-774-8250
  • Fax:
Mailing address:
  • Phone: 408-657-7276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: