Provider Demographics
NPI:1548240229
Name:ITZKOWITZ, SCOTT LOUIS (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LOUIS
Last Name:ITZKOWITZ
Suffix:
Gender:M
Credentials:DO
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 68
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-0068
Mailing Address - Country:US
Mailing Address - Phone:252-635-3906
Mailing Address - Fax:252-224-0378
Practice Address - Street 1:10614 RACETRACK RD STE 5
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3376
Practice Address - Country:US
Practice Address - Phone:410-629-1450
Practice Address - Fax:410-629-1460
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0064321207RG0100X
NC2015-01708207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1548240229Medicaid
NC1548240229Medicaid