Basic Information
Provider Information | |||||||||
NPI: | 1013231976 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCOTT | ||||||||
FirstName: | TAYLOR | ||||||||
MiddleName: | PAIGE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | REGIS | ||||||||
OtherFirstName: | TAYLOR | ||||||||
OtherMiddleName: | PAIGE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1111 BENFIELD BLVD STE 200 | ||||||||
Address2: |   | ||||||||
City: | MILLERSVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 211083004 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6676002494 | ||||||||
FaxNumber: | 6676004061 | ||||||||
Practice Location | |||||||||
Address1: | 1111 BENFIELD BLVD | ||||||||
Address2: | SUITE 104 | ||||||||
City: | MILLERSVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 211083002 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4107298494 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/22/2010 | ||||||||
LastUpdateDate: | 06/28/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/28/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | D73635 | MD | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.