Provider Demographics
NPI:1558552778
Name:SCOTLAND, TERRY ADERONKE
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:ADERONKE
Last Name:SCOTLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TERRY
Other - Middle Name:ADERONKE
Other - Last Name:SCOTLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:700 FORT WASHINGTON AVE
Mailing Address - Street 2:APT. 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3704
Mailing Address - Country:US
Mailing Address - Phone:347-565-3973
Mailing Address - Fax:
Practice Address - Street 1:1996 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5058
Practice Address - Country:US
Practice Address - Phone:212-781-7979
Practice Address - Fax:212-781-7963
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245304-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000695941Medicaid
NYW6L111Medicare UPIN
NY331947Medicare PIN