Provider Demographics
NPI:1922328756
Name:SCOTT, DORIS (CEO)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13048 MARQUETTE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3026
Mailing Address - Country:US
Mailing Address - Phone:301-755-7534
Mailing Address - Fax:
Practice Address - Street 1:13048 MARQUETTE LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3026
Practice Address - Country:US
Practice Address - Phone:301-755-7534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD002050800Medicaid