Provider Demographics
NPI:1174572598
Name:JABEN, SCOTT LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LEONARD
Last Name:JABEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3468
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-295-3468
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13244207W00000X
NC26271207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4066591OtherAETNA
NC45506OtherBCBS
NC0841725OtherUNITED HEALTHCARE
NC24174OtherKANAWHA
SC000000292723OtherUNISON HEALTH PLAN OF SC
NC17726OtherPARTNERS
SC771081OtherWELLCARE
NC8945506Medicaid
NC376563OtherMAMSI
SCN26271Medicaid
SC20002138OtherSELECT HEALTH OF SC
NC26675OtherWELLPATH
NC10725OtherBCBS MEDPOINT
NC10974OtherDOCTORS HEALTH PLAN
NC1641199001OtherCIGNA
NC175003OtherCOVENTRY
180030820OtherRAILROAD MEDICARE
NC75511OtherMEDCOST
NC175003OtherCOVENTRY
NC0264730010Medicare NSC
NC1641199001OtherCIGNA
NC26675OtherWELLPATH
NC75511OtherMEDCOST