Provider Demographics
NPI:1235121468
Name:STUART, SCOTT WILLIAM (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILLIAM
Last Name:STUART
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 THOUSAND OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7094
Mailing Address - Country:US
Mailing Address - Phone:843-572-0197
Mailing Address - Fax:843-876-1518
Practice Address - Street 1:3600 RIVERS AVE
Practice Address - Street 2:NAVAL HOSPITAL CHARLESTON
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7747
Practice Address - Country:US
Practice Address - Phone:843-976-1516
Practice Address - Fax:843-876-1518
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058154208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics