Provider Demographics
NPI:1225012990
Name:SCOTT, GREGORY MARSHALL (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MARSHALL
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 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-981-3660
Mailing Address - Fax:847-956-5108
Practice Address - Street 1:1614 W CENTRAL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2490
Practice Address - Country:US
Practice Address - Phone:847-818-1184
Practice Address - Fax:847-818-0980
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036--098106207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E28539Medicare UPIN
IL217147006Medicare PIN
IL745440009Medicare PIN
IL209308015Medicare PIN
L65368Medicare ID - Type Unspecified
ILP00965094Medicare PIN