Provider Demographics
NPI:1063796837
Name:SCOTT, CHARMAINE (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:CHARMAINE
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MEDICAL ASSISTANT
Mailing Address - Street 1:436 COMMERCE AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2501
Mailing Address - Country:US
Mailing Address - Phone:330-646-9398
Mailing Address - Fax:
Practice Address - Street 1:436 COMMERCE AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2501
Practice Address - Country:US
Practice Address - Phone:330-646-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH74057599172112010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical