Provider Demographics
NPI:1093760795
Name:SCOTT P. WACHHORST, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SCOTT P. WACHHORST, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:P
Authorized Official - Last Name:WACHHORST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-969-5227
Mailing Address - Street 1:1065 VALPARAISO AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4411
Mailing Address - Country:US
Mailing Address - Phone:650-969-5227
Mailing Address - Fax:650-969-5151
Practice Address - Street 1:701 E EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2833
Practice Address - Country:US
Practice Address - Phone:650-969-5227
Practice Address - Fax:650-969-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05277ZMedicare PIN