Provider Demographics
NPI:1538483078
Name:PAVIOL, SCOTT MAURICE (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MAURICE
Last Name:PAVIOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:704-873-4277
Mailing Address - Fax:704-344-0105
Practice Address - Street 1:2620 E 7TH ST STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4314
Practice Address - Country:US
Practice Address - Phone:704-358-9900
Practice Address - Fax:704-344-0105
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-02216207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCJ898AMedicare PIN