Provider Demographics
NPI:1235106410
Name:SMALL, ROY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:SCOTT
Last Name:SMALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:217 HARRISBURG AVE
Mailing Address - Street 2:THE HEART GROUP OF LGHEALTH
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2964
Mailing Address - Country:US
Mailing Address - Phone:717-544-8300
Mailing Address - Fax:717-544-8265
Practice Address - Street 1:217 HARRISBURG AVE
Practice Address - Street 2:THE HEART GROUP OF LGHEALTH
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2964
Practice Address - Country:US
Practice Address - Phone:717-544-8300
Practice Address - Fax:717-544-8265
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045288E207RA0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011990860003Medicaid
PAC88961Medicare UPIN
PA431806Medicare PIN