Provider Demographics
NPI:1447219498
Name:SCOTT, DAVID RANDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RANDOLPH
Last Name:SCOTT
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 836
Mailing Address - Street 2:
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413-0836
Mailing Address - Country:US
Mailing Address - Phone:757-442-6719
Mailing Address - Fax:757-442-7375
Practice Address - Street 1:10243 ROGERS DRIVE
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413
Practice Address - Country:US
Practice Address - Phone:757-442-6719
Practice Address - Fax:757-442-7375
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042418207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA051671OtherANTHEM BC/BS OF VA
VAC02245OtherMEDICARE PTAN
VACN3911OtherRAILROAD MEDICARE PTAN
VA322091OtherANTHEM BC/BS OF VA
VAC05079OtherMEDICARE PTAN
VA52411OtherOPTIMA HEALTH
VA006200907Medicaid
VACN3911OtherRAILROAD MEDICARE PTAN
VA160001361Medicare ID - Type Unspecified
VA051671OtherANTHEM BC/BS OF VA