Provider Demographics
NPI:1689727141
Name:SCOTT, KAREN J (PA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 DEFENSE HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7071
Mailing Address - Country:US
Mailing Address - Phone:410-266-9694
Mailing Address - Fax:410-266-9695
Practice Address - Street 1:122 DEFENSE HWY STE 210
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7071
Practice Address - Country:US
Practice Address - Phone:410-266-9694
Practice Address - Fax:410-266-9695
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002051363A00000X
MDC0002828363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD087575900Medicaid