MEDICARE: CAROL MARIE SCOTT PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	C0003950	MD

General Provider Information

NPI Number	:	1619970464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL MARIE SCOTT PA

Provider Business Mailing Address
First Line	:	8415 BELLONA LN
Second Line	:	SUITE 201
City	:	BALTIMORE
State	:	MD
Zip	:	21204-2055
Country	:	US
Telephone Number	:	410-821-7775
Fax Number	:	410-821-1320

Provider Business Practice Location Address
First Line	:	8415 BELLONA LN
Second Line	:	SUITE 201
City	:	BALTIMORE
State	:	MD
Zip	:	21204-2055
Country	:	US
Telephone Number	:	410-821-7775
Fax Number	:	410-821-1320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/09/2011

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Directions to “ CAROL MARIE SCOTT PA” Practice Location

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