Provider Demographics
NPI:1154365203
Name:SCOTT, STEPHEN M (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:M
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-635-9440
Mailing Address - Fax:859-448-2622
Practice Address - Street 1:300 COMMERCIAL DRIVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001
Practice Address - Country:US
Practice Address - Phone:859-635-9440
Practice Address - Fax:859-448-2622
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0101222Medicaid
KY080092522OtherRAILROAD MEDICARE
KY64214729Medicaid
KYP00839870OtherRAILROAD MEDICARE
KY008580096Medicare PIN
KY64214729Medicaid
KYC74833Medicare UPIN