Provider Demographics
NPI:1699906750
Name:SCOTT, COURTNEY S (MD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:S
Last Name:SCOTT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 N PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1412
Mailing Address - Country:US
Mailing Address - Phone:310-673-6581
Mailing Address - Fax:
Practice Address - Street 1:233 N PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1412
Practice Address - Country:US
Practice Address - Phone:310-673-6581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108390207P00000X, 207R00000X, 207RA0401X
NJ25MA12082900207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA12082900OtherSTATE MEDICAL LICENSE
KY59011OtherSTATE MEDICAL LICENSE
MA1014821OtherSTATE MEDICAL LICENSE
ID3171051OtherSTATE MEDICAL LICENSE
OH35149408OtherSTATE MEDICAL LICENSE
WV33396OtherSTATE MEDICAL LICENSE
TN70374OtherSTATE MEDICAL LICENSE
CAA108390OtherSTATE MEDICAL LICENSE
HIMD-23931-0OtherSTATE MEDICAL LICENSE
MTMED-PHYS-LIC-153908OtherSTATE MEDICAL LICENSE
FLME159046OtherSTATE MEDICAL LICENSE