Provider Demographics
NPI:1093807620
Name:SCOTT, ROXANE W (MD)
Entity Type:Individual
Prefix:
First Name:ROXANE
Middle Name:W
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 1:9229 UNIVERSITY BLVD
Mailing Address - Street 2:BLDG F STE 2-A
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:843-789-6975
Mailing Address - Fax:843-572-8135
Practice Address - Street 1:106 SPRINGVIEW LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8108
Practice Address - Country:US
Practice Address - Phone:843-873-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC190166Medicaid
SC190166Medicaid
SCH775823334Medicare ID - Type Unspecified