=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922090539
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIBEL RODRIGUEZ-SCOTT DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2005
-----------------------------------------------------
Last Update Date | 09/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2810 ASHLEY PHOSPHATE RD SUITE A-6
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29418-6405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-553-7744
-----------------------------------------------------
Fax | 843-553-7734
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2810 ASHLEY PHOSPHATE RD SUITE A-6
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29418-6405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-553-7744
-----------------------------------------------------
Fax | 843-553-7734
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 1134
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 1134
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------