Provider Demographics
NPI:1649272899
Name:SCOTT, MICHAELA G (MD)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:G
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2112
Mailing Address - Country:US
Mailing Address - Phone:772-231-3033
Mailing Address - Fax:
Practice Address - Street 1:1926 OCEAN DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2112
Practice Address - Country:US
Practice Address - Phone:772-231-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0025287207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D0276491OtherCLIA
FLCN9289OtherRR GROUP
FL044030200Medicaid
FL1017703OtherNCPDP
FLG8850OtherBCBS GROUP
FLCN9289OtherRR GROUP
FLD59933Medicare UPIN
FL4113630001Medicare ID - Type UnspecifiedDEMERC GROUP
FLG8850OtherBCBS GROUP
FL1017703OtherNCPDP