Provider Demographics
NPI:1801986096
Name:SCOTT, SAMUEL J JR (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:SCOTT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-2703
Mailing Address - Country:US
Mailing Address - Phone:703-241-1140
Mailing Address - Fax:
Practice Address - Street 1:1120 19TH ST NW
Practice Address - Street 2:SUITE 410
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3605
Practice Address - Country:US
Practice Address - Phone:202-463-6440
Practice Address - Fax:202-223-6525
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD5443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C62018Medicare UPIN