Provider Demographics
NPI:1891791687
Name:SCOTECE, CECELIA M (PA)
Entity type:Individual
Prefix:
First Name:CECELIA
Middle Name:M
Last Name:SCOTECE
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:5900 LAKE WRIGHT DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-1871
Mailing Address - Country:US
Mailing Address - Phone:757-213-5700
Mailing Address - Fax:757-213-5701
Practice Address - Street 1:5818 HARBOUR VIEW BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3315
Practice Address - Country:US
Practice Address - Phone:757-686-1042
Practice Address - Fax:757-686-1055
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2011-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA93771POtherOPTIMA
VA000373V25Medicare PIN
VAMC10191Medicare PIN
VA93771POtherOPTIMA