Provider Demographics
NPI:1700105020
Name:SHULTS-SCARLETT, SUSAN C (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:SHULTS-SCARLETT
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 1:10801 LOCKWOOD DR STE 230
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1559
Mailing Address - Country:US
Mailing Address - Phone:301-593-5566
Mailing Address - Fax:301-593-3644
Practice Address - Street 1:10801 LOCKWOOD DR STE 2325
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1556
Practice Address - Country:US
Practice Address - Phone:301-754-3050
Practice Address - Fax:301-618-0789
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038838208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine