Provider Demographics
NPI:1629094982
Name:SCOTT, MATTIE MARY SANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTIE
Middle Name:MARY SANDRA
Last Name:SCOTT
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 1:8423 HOLLY RD STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2488
Mailing Address - Country:US
Mailing Address - Phone:810-694-7095
Mailing Address - Fax:810-694-7224
Practice Address - Street 1:8423 HOLLY RD STE B
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2488
Practice Address - Country:US
Practice Address - Phone:810-694-7095
Practice Address - Fax:810-694-7224
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075129207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0986090OtherHEALTH PLUS OF MICHIGAN
MI4123288Medicaid
MI1972715977Medicaid
MI10111740001OtherTHE WELLNESS PLAN
MI19727715977Medicaid
MI2076271OtherUNITED HEALTH CARE
MI099270OtherTOTAL HEALTH CARE
MIC6735OtherMCARE
MI1692504601OtherBLUE CROSS BLUE SHIELD
MIP104137OtherBLUE CARE NETWORK