Provider Demographics
NPI:1821178047
Name:MORIN, SCOTT R (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:MORIN
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 1:984 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3196
Mailing Address - Country:US
Mailing Address - Phone:757-481-0385
Mailing Address - Fax:757-481-6946
Practice Address - Street 1:984 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 302
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3196
Practice Address - Country:US
Practice Address - Phone:757-481-0385
Practice Address - Fax:757-481-6946
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047881174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA251590OtherANTHEM BLUE SHIELD
VA35153OtherOPTIMA
VA6501818Medicaid
VA6501818Medicaid