1457404832 NPI number — DR. RICHARD MICHAEL SCANLON D.M.D.

Table of content: DR. RICHARD MICHAEL SCANLON D.M.D. (NPI 1457404832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457404832 NPI number — DR. RICHARD MICHAEL SCANLON D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCANLON
Provider First Name:
RICHARD
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457404832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 SANDY LN
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
LEWISTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17044-1310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-242-2731
Provider Business Mailing Address Fax Number:
717-242-1818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 SANDY LN
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-1310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-242-2731
Provider Business Practice Location Address Fax Number:
717-242-1818
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS-018602-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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