Provider Demographics
NPI:1629030978
Name:SCOTT, DAWN M (RPA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4117 MEDICAL CENTER DR
Mailing Address - Street 2:POD C
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-6600
Mailing Address - Country:US
Mailing Address - Phone:315-329-4968
Mailing Address - Fax:315-329-4969
Practice Address - Street 1:4117 MEDICAL CENTER DR
Practice Address - Street 2:POD C
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6600
Practice Address - Country:US
Practice Address - Phone:315-329-4968
Practice Address - Fax:315-329-4969
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY006103363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02508592Medicaid
NYCC5547Medicare ID - Type Unspecified
NY02508592Medicaid
NYJ400037552Medicare PIN