Basic Information
Provider Information
NPI: 1649437278
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCOTT
FirstName: RACHEL
MiddleName: ELLEN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1100 SOUTHFIELD DR STE 1370
Address2:  
City: PLAINFIELD
State: IN
PostalCode: 461684300
CountryCode: US
TelephoneNumber: 3178375566
FaxNumber: 3178375580
Practice Location
Address1: 112 HOSPITAL LN STE 100
Address2:  
City: DANVILLE
State: IN
PostalCode: 461222600
CountryCode: US
TelephoneNumber: 3177453740
FaxNumber: 3177453816
Other Information
ProviderEnumerationDate: 05/21/2008
LastUpdateDate: 03/09/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/09/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208200000X01065318AINY Allopathic & Osteopathic PhysiciansPlastic Surgery 
208600000X01065318AINN Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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