Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 198637 | NY |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 25MA06186400 | NJ |
NPI | 1124104138 |
---|---|
Provider Name | Dr. Randolph Patrick Scott |
First Address | Elmira, NY 14901-3230 |
Second Address | Elmira, NY 14905-1629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 30/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02150434 | (05) | NY |
8142505 | (05) | NJ |
G35840 | (02) |