Provider Demographics
NPI:1922090539
Name:RODRIGUEZ-SCOTT, MARIBEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:
Last Name:RODRIGUEZ-SCOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 ASHLEY PHOSPHATE RD
Mailing Address - Street 2:SUITE A-6
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-6405
Mailing Address - Country:US
Mailing Address - Phone:843-553-7744
Mailing Address - Fax:843-553-7734
Practice Address - Street 1:2810 ASHLEY PHOSPHATE RD
Practice Address - Street 2:SUITE A-6
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6405
Practice Address - Country:US
Practice Address - Phone:843-553-7744
Practice Address - Fax:843-553-7734
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC011347Medicaid
IL12706OtherBROAD CERTIFICATION
SCJBM04730OtherJUA
SC42D1077950OtherCLIA
SC1134OtherSTATE LICENSE NUMBER
SC10167OtherSC PCF
SCGP4815Medicaid
SCGP4815Medicaid
SCBR7899733OtherDEA
SCGP4815Medicaid