Provider Demographics
NPI:1841253275
Name:HARRISON, SCOTT (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLLINS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3153
Mailing Address - Country:US
Mailing Address - Phone:302-998-1151
Mailing Address - Fax:302-998-1154
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5400
Practice Address - Country:US
Practice Address - Phone:302-998-1151
Practice Address - Fax:302-998-1154
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0005412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001073903Medicaid
DE0001073903Medicaid
DEH26882Medicare UPIN