Provider Demographics
NPI:1740208933
Name:RANKIN, SCOTT VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:VINCENT
Last Name:RANKIN
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 1:276 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1042
Mailing Address - Country:US
Mailing Address - Phone:516-223-4759
Mailing Address - Fax:516-223-5712
Practice Address - Street 1:276 MOORE AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1042
Practice Address - Country:US
Practice Address - Phone:516-223-4759
Practice Address - Fax:516-223-5712
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191674-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01529877Medicaid
NY01529877Medicaid