Provider Demographics
NPI:1932229739
Name:GIRARD, SCOTT LIONEL (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:LIONEL
Last Name:GIRARD
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2950 PINE PLANTATION PKWY
Practice Address - Street 2:
Practice Address - City:OAK ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28461-0119
Practice Address - Country:US
Practice Address - Phone:910-454-4032
Practice Address - Fax:910-454-4033
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-01975207R00000X
NC1670208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC016707Medicaid
NC1932229739Medicaid
NCNCQ278BMedicare PIN
NC1932229739Medicaid
NCNCQ278CMedicare PIN
NCNCQ278AMedicare PIN