Provider Demographics
NPI:1366401184
Name:SINNOTT, SCOTT LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:LAWRENCE
Last Name:SINNOTT
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 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:3920 ST FRANCIS WAY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4917
Practice Address - Country:US
Practice Address - Phone:765-428-5990
Practice Address - Fax:765-428-5896
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052442A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10825958OtherCAQH NUMBER
IN000000110862OtherANTHEM PROVIDER NUMBER
IN200289870Medicaid
000000805393OtherANTHEM
IN9397472OtherPHCS PID NUMBER
IN815500F8Medicare PIN
IN000000110862OtherANTHEM PROVIDER NUMBER
IN10825958OtherCAQH NUMBER
IL6447860014Medicare NSC
IN160049970Medicare PIN
IN921480QQMedicare PIN
INM400044632Medicare PIN
IN9397472OtherPHCS PID NUMBER
ILIL3270242Medicare PIN
IN815460DDDMedicare PIN