Provider Demographics
NPI:1003847443
Name:SCOTT, JINEL ANGELA (MD)
Entity Type:Individual
Prefix:
First Name:JINEL
Middle Name:ANGELA
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 1:657 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1131
Mailing Address - Country:US
Mailing Address - Phone:917-273-2554
Mailing Address - Fax:
Practice Address - Street 1:657 E 24TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1131
Practice Address - Country:US
Practice Address - Phone:917-273-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361189922085R0202X
KY414152085R0202X
NY237071-12085R0202X
DCMD0370212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1451266Medicaid
KY7100058590Medicaid
PA102273260 0001Medicaid
IL036118992Medicaid
OK200273100AMedicaid
IL932T71OtherBCBS
IL932T71OtherBCBS
IL036118992Medicaid
DC171234YBFRMedicare PIN
PA102273260 0001Medicaid