Provider Demographics
NPI:1144331398
Name:SCOTT, CONSTANCE L (DO)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3785 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2433
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:6300 STATE STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603
Practice Address - Country:US
Practice Address - Phone:989-797-7546
Practice Address - Fax:989-797-6007
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012096207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0757300645OtherBCBSM
MI0757300645OtherBCBSM
MIOM65490Medicare ID - Type Unspecified