Provider Demographics
NPI:1316306228
Name:ELBERT, SCOTT CHARLES
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHARLES
Last Name:ELBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10713 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-4153
Mailing Address - Country:US
Mailing Address - Phone:540-273-1351
Mailing Address - Fax:
Practice Address - Street 1:10713 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-4153
Practice Address - Country:US
Practice Address - Phone:540-273-1351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000645237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter