Provider Demographics
NPI:1245306075
Name:WHITCOMB, SCOTT THOMAS (RN)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:THOMAS
Last Name:WHITCOMB
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:SCOTT
Other - Middle Name:THOMAS
Other - Last Name:WHITCOMB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:7391 FISHER RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9711
Mailing Address - Country:US
Mailing Address - Phone:315-524-6993
Mailing Address - Fax:315-524-6993
Practice Address - Street 1:7391 FISHER RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:NY
Practice Address - Zip Code:14519-9711
Practice Address - Country:US
Practice Address - Phone:315-524-6993
Practice Address - Fax:315-524-6993
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY510725-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01860360Medicaid