Provider Demographics
NPI:1265410864
Name:KOLSIN, SCOT BARRY (MD)
Entity type:Individual
Prefix:DR
First Name:SCOT
Middle Name:BARRY
Last Name:KOLSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1991 BALSLEY RD
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-6725
Mailing Address - Country:US
Mailing Address - Phone:315-539-9229
Mailing Address - Fax:315-539-0940
Practice Address - Street 1:1991 BALSLEY RD
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-6725
Practice Address - Country:US
Practice Address - Phone:315-539-9229
Practice Address - Fax:315-539-0940
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202183207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN