Provider Demographics
NPI:1164575031
Name:SCOTT, VAN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:VAN EDWARD
Middle Name:
Last Name:SCOTT
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 1:2017 WEST STATE STREET
Mailing Address - Street 2:SUITE I
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-1251
Mailing Address - Country:US
Mailing Address - Phone:724-652-3073
Mailing Address - Fax:724-652-3074
Practice Address - Street 1:2017 WEST STATE STREET
Practice Address - Street 2:SUITE I
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-1251
Practice Address - Country:US
Practice Address - Phone:724-652-3073
Practice Address - Fax:724-652-3074
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064157L208VP0000X
IN01047998208VP0000X
OH35062207208VP0000X
MI044463208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B45807Medicare UPIN
0637726Medicare ID - Type Unspecified