Provider Demographics
NPI:1386655686
Name:POULTON, SCOTT CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CRAIG
Last Name:POULTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FREDERICK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4647
Mailing Address - Country:US
Mailing Address - Phone:410-747-8773
Mailing Address - Fax:
Practice Address - Street 1:405 FREDERICK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4645
Practice Address - Country:US
Practice Address - Phone:410-747-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0674214 00Medicaid
MDE27756Medicare UPIN
MD0674214 00Medicaid