Provider Demographics
NPI:1417246745
Name:SCOTT, CARLA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-3218
Mailing Address - Country:US
Mailing Address - Phone:917-940-1282
Mailing Address - Fax:
Practice Address - Street 1:2111 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-3218
Practice Address - Country:US
Practice Address - Phone:917-940-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014715363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant