Provider Demographics
NPI:1053905539
Name:SCOTT, BARRY L
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 LOUGH LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:26288-8586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 LOUGH LN
Practice Address - Street 2:
Practice Address - City:WEBSTER SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:26288-8586
Practice Address - Country:US
Practice Address - Phone:304-847-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker