Provider Demographics
NPI:1437140670
Name:CARLOS, SCOTT A (MD)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:CARLOS
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 1:40 MEDICAL PARK
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6392
Mailing Address - Country:US
Mailing Address - Phone:304-243-3880
Mailing Address - Fax:304-243-3895
Practice Address - Street 1:40 MEDICAL PARK
Practice Address - Street 2:SUITE 401
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6392
Practice Address - Country:US
Practice Address - Phone:304-243-3880
Practice Address - Fax:304-243-3895
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23792207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT79956Medicaid
SCT79956Medicaid
P00104919Medicare PIN
SCH941407730Medicare PIN