Provider Demographics
NPI:1407876675
Name:MCCUNE, SCOTT ALAN (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:MCCUNE
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-5600
Mailing Address - Fax:704-316-5613
Practice Address - Street 1:10030 GILEAD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7545
Practice Address - Country:US
Practice Address - Phone:704-316-5600
Practice Address - Fax:704-316-5613
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0093-00755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1113COtherNCBCBS
NC891113CMedicaid
NC891113CMedicaid
NC2196114EMedicare PIN
1113COtherNCBCBS