Provider Demographics
NPI:1912903188
Name:LUKING, SCOTT ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALFRED
Last Name:LUKING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:520 MAPLE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-4600
Mailing Address - Country:US
Mailing Address - Phone:336-634-3960
Mailing Address - Fax:336-634-3919
Practice Address - Street 1:520 MAPLE AVE
Practice Address - Street 2:STE B
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-4600
Practice Address - Country:US
Practice Address - Phone:336-634-3960
Practice Address - Fax:336-634-3919
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC34385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8953168Medicaid
NC8953168Medicaid
NC2164517AMedicare ID - Type Unspecified