Provider Demographics
NPI:1669695128
Name:MARDER, SCOTT D (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:MARDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 BRAMBACH AVE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5236
Mailing Address - Country:US
Mailing Address - Phone:914-774-9006
Mailing Address - Fax:914-725-0063
Practice Address - Street 1:2 BRAMBACH AVE
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5236
Practice Address - Country:US
Practice Address - Phone:914-774-9006
Practice Address - Fax:914-725-0063
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0395372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH35250Medicare UPIN