Provider Demographics
NPI:1003835562
Name:SCOTT, PATRICIA BEATRICE ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:BEATRICE ROSE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 TAMAL VISTA BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1159
Mailing Address - Country:US
Mailing Address - Phone:707-547-9004
Mailing Address - Fax:
Practice Address - Street 1:240 TAMAL VISTA BLVD STE 290
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1159
Practice Address - Country:US
Practice Address - Phone:707-547-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38560174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A385600Medicare ID - Type Unspecified