Provider Demographics
NPI:1780619577
Name:MALONE-SCOTT, LAURA-ANNE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:LAURA-ANNE
Middle Name:
Last Name:MALONE-SCOTT
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1953
Mailing Address - Country:US
Mailing Address - Phone:203-980-4788
Mailing Address - Fax:
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:HOSPITAL OF ST RAPHAEL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3955
Practice Address - Fax:203-789-4037
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001681363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
970002186Medicare PIN
Q58707Medicare UPIN
CT970002020Medicare ID - Type Unspecified