Provider Demographics
NPI:1609816768
Name:SCOTT-MCKINNEY, STACY DENISE (MD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:DENISE
Last Name:SCOTT-MCKINNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13900 LAUREL LAKES AVENUE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5046
Mailing Address - Country:US
Mailing Address - Phone:301-498-1900
Mailing Address - Fax:301-497-9885
Practice Address - Street 1:13900 LAUREL LAKES AVENUE
Practice Address - Street 2:SUITE 240
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5046
Practice Address - Country:US
Practice Address - Phone:301-498-1900
Practice Address - Fax:301-497-9885
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041884208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD199411500Medicaid
MD000P32133Medicare ID - Type Unspecified
MD199411500Medicaid