Provider Demographics
NPI:1245231745
Name:SCANLAN, RICK L (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:L
Last Name:SCANLAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-2022
Mailing Address - Country:US
Mailing Address - Phone:412-561-7828
Mailing Address - Fax:412-561-2339
Practice Address - Street 1:733 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-2022
Practice Address - Country:US
Practice Address - Phone:412-561-7828
Practice Address - Fax:412-561-2339
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-004512-L213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01837214Medicaid
PA021701L2WMedicare PIN
PAU73012Medicare UPIN