Provider Demographics
NPI:1245218163
Name:SCOTT, DIANA L (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
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 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:
Practice Address - Street 1:175 MADISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2099
Practice Address - Country:US
Practice Address - Phone:609-914-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445967207V00000X
NJ25MA06948700207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029028750002Medicaid
PA2727175OtherHIGHMARK BLUE SHIELD
PA7772245OtherAETNA
PAP01457109OtherRAILROAD MEDICARE
PA30202364OtherKEYSTONE FIRST
PA1999465OtherCIGNA PA
PA3888590000OtherKEYSTONE IBC
NJ8571503Medicaid
H40502Medicare UPIN
NJ8571503Medicaid