Provider Demographics
NPI:1497741631
Name:SCOTT, DEBORAH JL (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JL
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JO LONG
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:74 PLEASANT STREET
Mailing Address - Street 2:STE 204
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257
Mailing Address - Country:US
Mailing Address - Phone:603-526-4635
Mailing Address - Fax:603-526-8283
Practice Address - Street 1:240 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4411
Practice Address - Country:US
Practice Address - Phone:603-515-2093
Practice Address - Fax:603-515-2031
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0008564207R00000X
NH8764207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3079917Medicaid
VT8000419Medicaid
NHT400323772Medicare PIN
NH3079917Medicaid
I33659Medicare UPIN