Provider Demographics
NPI:1437425436
Name:LEOPOLD, SCOTT MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MATTHEW
Last Name:LEOPOLD
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 1:1827 E WASHINGTON AVE APT 449
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5248
Mailing Address - Country:US
Mailing Address - Phone:860-798-8303
Mailing Address - Fax:
Practice Address - Street 1:UNIVERISTY OF WI HOSPITALS AND CLINICS, ATTN GME OFFICE
Practice Address - Street 2:749 UNIVERSITY ROW, SUITE 200
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705
Practice Address - Country:US
Practice Address - Phone:608-263-0572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-24
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH57.021455208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program