Provider Demographics
NPI:1811270127
Name:BURGESS, SCOTT (SCOTT BURGESS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:BURGESS
Suffix:
Gender:M
Credentials:SCOTT BURGESS
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:710 WHITE SWAN DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1519
Mailing Address - Country:US
Mailing Address - Phone:410-757-0753
Mailing Address - Fax:
Practice Address - Street 1:710 WHITE SWAN DR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1519
Practice Address - Country:US
Practice Address - Phone:410-757-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026658207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology