Provider Demographics
NPI:1093893430
Name:PALUSKA, SCOTT A (MD)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:PALUSKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9701
Mailing Address - Country:US
Mailing Address - Phone:802-878-1008
Mailing Address - Fax:802-872-2679
Practice Address - Street 1:28 PARK AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9701
Practice Address - Country:US
Practice Address - Phone:802-878-1008
Practice Address - Fax:802-872-2679
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110491207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361104911Medicaid
IL19243OtherPERS CARE
IL0361104911Medicaid
ILK05629Medicare ID - Type Unspecified