Provider Demographics
NPI:1982603759
Name:ABBOTT, PETER SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:SCOTT
Last Name:ABBOTT
Suffix:
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 1:6141 MASSEY CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:WILLARDS
Mailing Address - State:MD
Mailing Address - Zip Code:21874-1174
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6141 MASSEY CROSSING RD
Practice Address - Street 2:
Practice Address - City:WILLARDS
Practice Address - State:MD
Practice Address - Zip Code:21874-1174
Practice Address - Country:US
Practice Address - Phone:410-835-2356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1184832040OtherGROUP NPI
MD380091100Medicaid
DE0000241001Medicaid
MDK230S443Medicaid
MD380091100Medicaid