1356725634 NPI number — BRENDA A. SCOTT

Table of content: BRENDA A. SCOTT (NPI 1356725634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356725634 NPI number — BRENDA A. SCOTT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
BRENDA
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
BRENDA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSAC, LAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356725634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 WILLIAM J HTS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702-6134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-678-8812
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 WILLIAM J HTS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702-6134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-678-8812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2015

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: 171100000X , with the licence number:  265039 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 265039 . This is a "MA BOARD OF REGISTRATION IN MEDICINE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 139198 . This is a "NATIONAL CERTIFICATION COMMISSION FOR ACUPUNCTURE & ORIENTAL MEDICINE" identifier . This identifiers is of the category "OTHER".