Provider Demographics
NPI:1114308020
Name:PAITL, SCOTTIE GALIK (MD)
Entity Type:Individual
Prefix:
First Name:SCOTTIE
Middle Name:GALIK
Last Name:PAITL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 HADDONFIELD BERLIN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3520
Mailing Address - Country:US
Mailing Address - Phone:856-782-2212
Mailing Address - Fax:856-782-2212
Practice Address - Street 1:1000 HADDONFIELD BERLIN RD STE 210
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3520
Practice Address - Country:US
Practice Address - Phone:856-782-2212
Practice Address - Fax:856-782-2212
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.1465982080N0001X, 2080N0001X
MI4301108161390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine