Provider Demographics
NPI:1386787745
Name:SCOTT, THOMAS WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WALTER
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 1:106 LITTLE FALLS ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4313
Mailing Address - Country:US
Mailing Address - Phone:703-241-1851
Mailing Address - Fax:703-241-9597
Practice Address - Street 1:106 LITTLE FALLS ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4313
Practice Address - Country:US
Practice Address - Phone:703-241-1851
Practice Address - Fax:703-241-9597
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028459174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC88618Medicare UPIN
VASC407217Medicare ID - Type Unspecified