Provider Demographics
NPI:1376506345
Name:SCOTT W. NUTTER, DPM, PA
Entity Type:Organization
Organization Name:SCOTT W. NUTTER, DPM, PA
Other - Org Name:LAUREL LAKES FOOT AND ANKLE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:NUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, PA
Authorized Official - Phone:301-317-6800
Mailing Address - Street 1:13950 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5000
Mailing Address - Country:US
Mailing Address - Phone:301-317-6800
Mailing Address - Fax:301-317-4183
Practice Address - Street 1:13950 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5000
Practice Address - Country:US
Practice Address - Phone:301-317-6800
Practice Address - Fax:301-317-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP14048213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0892190001Medicare NSC
MD480006885Medicare PIN
MD000A30507Medicare PIN
MD100M988EMedicare PIN
MD100MMedicare PIN
DCG00007Medicare PIN
MDT30895Medicare UPIN