Provider Demographics
NPI:1467457275
Name:GOLDE, SCOTT A (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:GOLDE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2009
Mailing Address - Country:US
Mailing Address - Phone:937-382-1616
Mailing Address - Fax:
Practice Address - Street 1:1184 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2009
Practice Address - Country:US
Practice Address - Phone:937-382-1616
Practice Address - Fax:937-382-7877
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-1016363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOO69292Medicaid
OHOO69292Medicaid
OHS58160Medicare UPIN
OHH136912Medicare PIN
OHPA30281Medicare PIN