Provider Demographics
NPI:1346512605
Name:GERRISH, SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:GERRISH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PLEASANT ST SW
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5609
Mailing Address - Country:US
Mailing Address - Phone:703-255-5580
Mailing Address - Fax:703-255-5587
Practice Address - Street 1:112 PLEASANT ST SW
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5609
Practice Address - Country:US
Practice Address - Phone:703-255-5580
Practice Address - Fax:703-255-5587
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050246207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine