Basic Information
| Provider Information | |||||||||
| NPI: | 1114365905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARTKOSKI | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | JACOB | ||||||||
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| Credential: | M.D, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2920 HIGHWOODS BLVD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276040010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774984490 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 COTTEN LN | ||||||||
| Address2: | ST 2 | ||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192356555 | ||||||||
| FaxNumber: | 9192356584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2013 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2013017420 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2020-03839 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1114365905 | 05 | NC | MEDICAID |