Provider Demographics
NPI:1245240548
Name:SCANLON, MARY NOCERO (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:NOCERO
Last Name:SCANLON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5733 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067
Mailing Address - Country:US
Mailing Address - Phone:954-346-8347
Mailing Address - Fax:561-582-4393
Practice Address - Street 1:101 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-4228
Practice Address - Country:US
Practice Address - Phone:561-582-4151
Practice Address - Fax:561-582-4393
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I40432Medicare UPIN
FLU5624Medicare PIN