Provider Demographics
NPI:1578562211
Name:SCOTT, MARTIN J (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2312 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1953
Mailing Address - Country:US
Mailing Address - Phone:609-890-6363
Mailing Address - Fax:609-588-5225
Practice Address - Street 1:2312 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1953
Practice Address - Country:US
Practice Address - Phone:609-890-6363
Practice Address - Fax:609-588-5225
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB04074700207Q00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC52772Medicare UPIN