Provider Demographics
NPI:1275517245
Name:SCOTT, JORDAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:E
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:79 ERDMAN WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-537-4805
Mailing Address - Fax:978-537-2185
Practice Address - Street 1:79 ERDMAN WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-537-4805
Practice Address - Fax:978-537-2185
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA214922207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2119552Medicaid
MA2119552Medicaid
I56739Medicare UPIN