1043417314 NPI number — SCOTT EDWARD KNOWLTON DO

Table of content: SCOTT EDWARD KNOWLTON DO (NPI 1043417314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043417314 NPI number — SCOTT EDWARD KNOWLTON DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNOWLTON
Provider First Name:
SCOTT
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043417314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10026 OLD OCEAN CITY BLVD
Provider Second Line Business Mailing Address:
BUILDING ONE
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21811-1288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-641-9450
Provider Business Mailing Address Fax Number:
410-641-9515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9733 HEALTHWAY DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811-1288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-641-9450
Provider Business Practice Location Address Fax Number:
410-641-9515
Provider Enumeration Date:
06/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  H0065789 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00463615 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P00463615 CD0426 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: KP95S106 . This is a "UNSPECIFIED" identifier . This identifiers is of the category "OTHER".




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