Provider Demographics
NPI:1215142971
Name:SCOTT, RONALD JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MULE RD STE E8
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5052
Mailing Address - Country:US
Mailing Address - Phone:732-341-6070
Mailing Address - Fax:732-341-6077
Practice Address - Street 1:9 MULE RD STE E8
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5052
Practice Address - Country:US
Practice Address - Phone:732-341-6070
Practice Address - Fax:732-341-6077
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA00113L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJOTH000Medicare UPIN
NJ166061C2HMedicare PIN