Provider Demographics
NPI:1003943465
Name:SCOTT, LISA C (PHYSICIANS ASSISTANT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 WOLF ACRES DRIVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550
Mailing Address - Country:US
Mailing Address - Phone:301-334-4400
Mailing Address - Fax:301-334-8228
Practice Address - Street 1:69 WOLF ACRES DRIVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:301-334-4400
Practice Address - Fax:301-334-8228
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC01892363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q10846Medicare UPIN