Provider Demographics
NPI:1750584991
Name:CORMAN, SCOTT ANDREW (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ANDREW
Last Name:CORMAN
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 1:4841 MONROE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4385
Mailing Address - Country:US
Mailing Address - Phone:248-302-0064
Mailing Address - Fax:
Practice Address - Street 1:4841 MONROE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4385
Practice Address - Country:US
Practice Address - Phone:419-471-1317
Practice Address - Fax:419-471-1316
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-009084207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2759859Medicaid
OHCA4246Medicare UPIN