Basic Information
| Provider Information | |||||||||
| NPI: | 1043207327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EARLY | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 MERRIMACK ST STE 9 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018431764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786556652 | ||||||||
| FaxNumber: | 9789847384 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 MERRIMACK ST STE 9 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018431764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786556652 | ||||||||
| FaxNumber: | 9789847384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 08/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 77012 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.