Provider Demographics
NPI:1477506186
Name:OOSTERVEEN, SCOTT R (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:OOSTERVEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:60 COMMERCIAL ST STE 404
Mailing Address - Street 2:CONCORD HOSPITAL MEDICAL OFFICE AT HORSESHOE POND
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5096
Mailing Address - Country:US
Mailing Address - Phone:603-228-1763
Mailing Address - Fax:
Practice Address - Street 1:60 COMMERCIAL ST STE 404
Practice Address - Street 2:CONCORD HOSPITAL MEDICAL OFFICE AT HORSESHOE POND
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5096
Practice Address - Country:US
Practice Address - Phone:603-228-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431420207RG0100X
NH16487207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410413700Medicaid
PAP00444706OtherRAILROAD MEDICARE
PA1567068OtherGATEWAY-WMG
PA30089000OtherAMERIHEALTH MERCY-WMG
PA416564OtherUPMC-WMG
PA1963228OtherHIGHMARK BLUE SHIELD
PA50069579OtherCAPITAL BLUE CROSS
PA102054344Medicaid
PA102054344Medicaid
PA1567068OtherGATEWAY-WMG
PA50069579OtherCAPITAL BLUE CROSS
MDO350Medicare PIN