Provider Demographics
NPI:1275585853
Name:VANDUZER, SCOTT T (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name:VANDUZER
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 1:5141 OAKLAND RD
Mailing Address - Street 2:
Mailing Address - City:SLATINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18080-4143
Mailing Address - Country:US
Mailing Address - Phone:484-719-7426
Mailing Address - Fax:
Practice Address - Street 1:5141 OAKLAND RD
Practice Address - Street 2:
Practice Address - City:SLATINGTON
Practice Address - State:PA
Practice Address - Zip Code:18080-4143
Practice Address - Country:US
Practice Address - Phone:484-719-7426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066853L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017194260004Medicaid
G77512Medicare UPIN
PA0017194260004Medicaid