Provider Demographics
NPI:1376529651
Name:SCOTT, NORMAN BRUCE (DO)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:BRUCE
Last Name:SCOTT
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 1:9732 STATE ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:COPENHAGEN
Mailing Address - State:NY
Mailing Address - Zip Code:13626-2906
Mailing Address - Country:US
Mailing Address - Phone:315-688-2305
Mailing Address - Fax:315-688-2139
Practice Address - Street 1:9732 STATE ROUTE 12
Practice Address - Street 2:
Practice Address - City:COPENHAGEN
Practice Address - State:NY
Practice Address - Zip Code:13626-2906
Practice Address - Country:US
Practice Address - Phone:315-688-2305
Practice Address - Fax:315-688-2139
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02101233Medicaid
VAD000Medicare UPIN
NYJ400140376Medicare PIN
NY02101233Medicaid
NYJ400140377Medicare PIN