Provider Demographics
NPI:1124098298
Name:SCOTT, SHIRLEY KATE (MD)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:KATE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10660 PARK RD
Practice Address - Street 2:STE 2100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8413
Practice Address - Country:US
Practice Address - Phone:980-442-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99013142086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3753Medicaid
SCN00139Medicaid
NC1124098298Medicaid
SCN00139Medicaid
SCGP3753Medicaid
SCAA01897797Medicare PIN
SCAA01897772Medicare PIN
NC1124098298Medicaid