Provider Demographics
NPI:1992951875
Name:CORDELL, SCOTT EDWARD (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:EDWARD
Last Name:CORDELL
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4901 DAWN DR STE 2300
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-8287
Practice Address - Country:US
Practice Address - Phone:910-738-1065
Practice Address - Fax:910-738-5143
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002010A363A00000X
OH50.002627RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INPENDINGOtherANTHEM BCBS
INOPRMedicaid
OH0110947Medicaid
IN259370147Medicare PIN
OHH461000Medicare PIN