Provider Demographics
NPI:1508814591
Name:SCOTT, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
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 13005
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-3005
Mailing Address - Country:US
Mailing Address - Phone:336-274-4285
Mailing Address - Fax:336-268-9062
Practice Address - Street 1:1317 N ELM ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1033
Practice Address - Country:US
Practice Address - Phone:336-274-4285
Practice Address - Fax:336-268-9062
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00155802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC75031OtherBCBS
NC8975031Medicaid
NC73486OtherMEDCOST
NC1600066OtherUNITED HEALTHCARE
NC24730OtherPARTNERS
NC73486OtherMEDCOST
NC24730OtherPARTNERS