Provider Demographics
NPI:1346290889
Name:SCOTT, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2123 AUBURN AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-241-5489
Mailing Address - Fax:513-241-5490
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-241-5489
Practice Address - Fax:513-241-5490
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.063315S207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100355960AMedicaid
OH0882862Medicaid
KY64931199Medicaid
OHF07131Medicare UPIN
IN100355960AMedicaid