Provider Demographics
NPI:1144220856
Name:MARINELLI, SCOTT ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANTHONY
Last Name:MARINELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5346 CLUBHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-9794
Mailing Address - Country:US
Mailing Address - Phone:910-483-2448
Mailing Address - Fax:
Practice Address - Street 1:5346 CLUBHOUSE LN
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-9794
Practice Address - Country:US
Practice Address - Phone:910-483-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133MPOtherBCBS OF NC GROUP #015CK
NC89133MPMedicaid
NC133MPOtherBCBS OF NC GROUP #015CK