Provider Demographics
NPI:1962476713
Name:SCOTT, KEVIN R (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:SCOTT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3700 JOSEPH SIEWICK DR
Mailing Address - Street 2:STE. 400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1744
Mailing Address - Country:US
Mailing Address - Phone:703-620-4300
Mailing Address - Fax:730-620-4367
Practice Address - Street 1:3700 JOSEPH SIEWICK DR
Practice Address - Street 2:STE. 400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1744
Practice Address - Country:US
Practice Address - Phone:703-620-4300
Practice Address - Fax:730-620-4367
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2010-02-25
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Provider Licenses
StateLicense IDTaxonomies
VA0101047061207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006305245Medicaid
VA006305245Medicaid
VA697477Medicare PIN