Provider Demographics
NPI:1043417314
Name:KNOWLTON, SCOTT EDWARD (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:EDWARD
Last Name:KNOWLTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10026 OLD OCEAN CITY BLVD
Mailing Address - Street 2:BUILDING ONE
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1288
Mailing Address - Country:US
Mailing Address - Phone:410-641-9450
Mailing Address - Fax:410-641-9515
Practice Address - Street 1:9733 HEALTHWAY DRIVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1288
Practice Address - Country:US
Practice Address - Phone:410-641-9450
Practice Address - Fax:410-641-9515
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0065789207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00463615OtherRAILROAD MEDICARE
P00463615 CD0426OtherRAILROAD MEDICARE
KP95S106OtherUNSPECIFIED
MDP00463615OtherRAILROAD MEDICARE