Provider Demographics
NPI:1972782142
Name:NUTTER, SCOTT W
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:NUTTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13950 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5000
Mailing Address - Country:US
Mailing Address - Phone:301-317-6800
Mailing Address - Fax:301-317-4183
Practice Address - Street 1:13950 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5000
Practice Address - Country:US
Practice Address - Phone:301-317-6800
Practice Address - Fax:301-317-4183
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00560213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA252513OtherBLUE SHIELD OF VA
91242OtherAETNA
A050OtherAMERIGROUP
MD41866201OtherBLUE SHIELD OF MD
MD7998686000Medicaid
MD91242OtherMAMSI
998EOtherTRICARE
DC0001OtherBLUE SHIELD OF DC
496067OtherNCPPO
MD41866201OtherBLUE SHIELD OF MD
DCT30895Medicare UPIN
MD91242OtherMAMSI
DC000A30507Medicare PIN