Provider Demographics
NPI:1326061508
Name:DESSAIN, SCOTT K (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:K
Last Name:DESSAIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:615 CHESTNUT ST
Mailing Address - Street 2:14TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4404
Mailing Address - Country:US
Mailing Address - Phone:215-955-1175
Mailing Address - Fax:215-955-2420
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:SUITE 4240
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-8874
Practice Address - Fax:215-955-2340
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD420102207R00000X, 207RX0202X
PAMD-420102207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9025502Medicaid
NJ9025502Medicaid