Provider Demographics
NPI:1629064639
Name:SCOTT, DOUGLAS R (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:R
Last Name:SCOTT
Suffix:
Gender:M
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:PO BOX 7625
Mailing Address - Street 2:
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03247-7625
Mailing Address - Country:US
Mailing Address - Phone:603-524-2020
Mailing Address - Fax:603-528-2805
Practice Address - Street 1:368 HOUNSELL AVE
Practice Address - Street 2:
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6922
Practice Address - Country:US
Practice Address - Phone:603-524-2020
Practice Address - Fax:603-528-2805
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8400207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3084410Medicaid
NHNX2238Medicare PIN
NH1295875383Medicare PIN
NHE12402Medicare UPIN
NH3084410Medicaid
NHNX2238Medicare UPIN