Provider Demographics
NPI:1710999230
Name:SCOTT, ROBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1163 ROUTE 37 WEST
Mailing Address - Street 2:BLDG B-3
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-557-9012
Mailing Address - Fax:732-557-9015
Practice Address - Street 1:1163 ROUTE 37 WEST
Practice Address - Street 2:BLDG B-3
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-557-9012
Practice Address - Fax:732-557-9015
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06585300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7765606Medicaid
NJ7765606Medicaid
G26149Medicare UPIN