Provider Demographics
NPI:1902828478
Name:VERMILLION, SCOT STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:STANLEY
Last Name:VERMILLION
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:PO BOX 11167
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-1167
Mailing Address - Country:US
Mailing Address - Phone:865-584-7376
Mailing Address - Fax:
Practice Address - Street 1:1420 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4279
Practice Address - Country:US
Practice Address - Phone:423-638-7057
Practice Address - Fax:423-638-5824
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96000612085R0202X
GA0399732085R0202X
TN260072085R0202X
FLME881452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891015VMedicaid
TN3000735Medicaid
TN3000735Medicaid
TN3000735Medicare UPIN
G11047Medicare UPIN
VA010253055Medicaid
VA010252199Medicaid
VA010251958Medicaid
NC2234568AMedicare ID - Type Unspecified
VA010252237Medicaid