Provider Demographics
NPI:1457319253
Name:NEVILLE, SCOTT M (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:NEVILLE
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 1:1001 HADLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1794
Mailing Address - Country:US
Mailing Address - Phone:317-834-5777
Mailing Address - Fax:317-834-5776
Practice Address - Street 1:1001 HADLEY RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1794
Practice Address - Country:US
Practice Address - Phone:317-834-5777
Practice Address - Fax:317-834-5776
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001016A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000477927OtherANTHEM PIN
INV10079Medicare UPIN
IN237460AMedicare PIN