Provider Demographics
NPI:1699755710
Name:SCOTT, GEORGE J (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1474 TANYARD ROAD
Mailing Address - Street 2:SUITE D100
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1135
Mailing Address - Country:US
Mailing Address - Phone:856-566-6265
Mailing Address - Fax:609-704-0195
Practice Address - Street 1:1474 TANYARD ROAD
Practice Address - Street 2:SUITE D100
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1135
Practice Address - Country:US
Practice Address - Phone:609-704-0185
Practice Address - Fax:609-704-0195
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB06817600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8250600Medicaid
NJ038217ASDMedicare ID - Type Unspecified
NJ8250600Medicaid