Provider Demographics
NPI:1649393679
Name:WOMACK, SCOTT GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:GREGORY
Last Name:WOMACK
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 1:110 SOUTH PANTOPS DR.
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911
Mailing Address - Country:US
Mailing Address - Phone:434-977-5160
Mailing Address - Fax:434-977-5202
Practice Address - Street 1:110 S PANTOPS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8672
Practice Address - Country:US
Practice Address - Phone:434-977-5160
Practice Address - Fax:434-977-5202
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241345207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00427498OtherPALMETTO RR MEDICARE
VA301551OtherANTHEM
VA0756400001OtherDMERC
VA301551OtherANTHEM