Provider Demographics
NPI:1598789281
Name:SCOTT, DEBORAH ANNETTE (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNETTE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-801-3097
Mailing Address - Fax:704-896-2344
Practice Address - Street 1:9625 NORTHCROSS CENTER CT
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7348
Practice Address - Country:US
Practice Address - Phone:704-801-3097
Practice Address - Fax:704-896-2344
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC24043208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891232YMedicaid
SCN24043Medicaid
SCN24043Medicaid
NC203726AMedicare PIN