Provider Demographics
NPI:1952540981
Name:SCOTT, WALTER (LAC)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12282 BONMOT PLACE
Mailing Address - Street 2:
Mailing Address - City:RESITERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136
Mailing Address - Country:US
Mailing Address - Phone:443-904-0364
Mailing Address - Fax:
Practice Address - Street 1:6 PARKS AVE
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-4937
Practice Address - Country:US
Practice Address - Phone:443-904-0364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-15
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01697171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist