Provider Demographics
NPI:1760919930
Name:HOPSON, SCOTT DAVISSON (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVISSON
Last Name:HOPSON
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CARROLL PKWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4973
Mailing Address - Country:US
Mailing Address - Phone:301-514-7739
Mailing Address - Fax:
Practice Address - Street 1:650 CARROLL PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4973
Practice Address - Country:US
Practice Address - Phone:301-514-7739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA003132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00313OtherMARYLAND BOARD OF PHYSICIANS