Provider Demographics
NPI:1144417478
Name:SCOTT, MARVELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVELL
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 LEXINGTON AVE
Mailing Address - Street 2:SUITE 1903
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6837
Mailing Address - Country:US
Mailing Address - Phone:212-486-8616
Mailing Address - Fax:212-486-8621
Practice Address - Street 1:570 LEXINGTON AVE
Practice Address - Street 2:SUITE 1903
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6837
Practice Address - Country:US
Practice Address - Phone:212-486-8616
Practice Address - Fax:212-486-8621
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241676-1261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty