Provider Demographics
NPI:1528217767
Name:SCOTT, DEWITT RANDOLPH (RPA)
Entity Type:Individual
Prefix:MR
First Name:DEWITT
Middle Name:RANDOLPH
Last Name:SCOTT
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8931 161ST ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-6102
Mailing Address - Country:US
Mailing Address - Phone:845-548-6567
Mailing Address - Fax:212-526-6169
Practice Address - Street 1:5A ETHAN ALLEN DR
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-1802
Practice Address - Country:US
Practice Address - Phone:845-548-6567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000779363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical