Individual
DR. SHANNON ELLIOTT SCOTT-VERNAGLIA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT ST YAW 6D, PEDIATRIC GROUP PRACTICE, BOSTON, MA 02114-2696
(617) 726-2728
(617) 724-3948
Mailing address
PO BOX 9142, MASS. GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
210192
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0168718
—
MA
01
—
210192
TUFTS HEALTH PLAN
MA
01
—
J24685
BCBS OF MA
MA
Enumeration date
12/06/2005
Last updated
07/08/2007
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