Provider Demographics
NPI:1679690663
Name:SCOTT, CORIDALIA WALD (MD)
Entity Type:Individual
Prefix:DR
First Name:CORIDALIA
Middle Name:WALD
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CORIDALIA
Other - Middle Name:
Other - Last Name:WALD-SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 13029
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-3029
Mailing Address - Country:US
Mailing Address - Phone:336-510-1120
Mailing Address - Fax:336-510-1159
Practice Address - Street 1:1100 REVOLUTION MILL DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5067
Practice Address - Country:US
Practice Address - Phone:336-510-1120
Practice Address - Fax:336-510-1159
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22318207ZC0500X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE30800Medicare UPIN