Basic Information
Provider Information
NPI: 1881032787
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCOTT
FirstName: DOUGLAS
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2966 STREET RD
Address2:  
City: BENSALEM
State: PA
PostalCode: 190202604
CountryCode: US
TelephoneNumber: 2156380666
FaxNumber: 2156383320
Practice Location
Address1: 2966 STREET RD
Address2:  
City: BENSALEM
State: PA
PostalCode: 190202604
CountryCode: US
TelephoneNumber: 2156380666
FaxNumber: 2156383320
Other Information
ProviderEnumerationDate: 06/13/2013
LastUpdateDate: 11/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XMD461560PAN Allopathic & Osteopathic PhysiciansEmergency Medicine 
207P00000X25MA10937400NJN Allopathic & Osteopathic PhysiciansEmergency Medicine 
207P00000X35.131591OHY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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