Provider Demographics
NPI:1720080575
Name:SCOTT, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 INDUSTRIAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3464
Mailing Address - Country:US
Mailing Address - Phone:508-539-6189
Mailing Address - Fax:508-539-6134
Practice Address - Street 1:5 INDUSTRIAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3464
Practice Address - Country:US
Practice Address - Phone:508-539-6189
Practice Address - Fax:508-539-6134
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP1692363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q08826Medicare UPIN
AP2081Medicare ID - Type Unspecified