Provider Demographics
NPI:1477501229
Name:CLINGAN, SCOTT ANDREW (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ANDREW
Last Name:CLINGAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:814 GREENBRIER CIR
Mailing Address - Street 2:STE F
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2643
Mailing Address - Country:US
Mailing Address - Phone:757-842-7010
Mailing Address - Fax:757-312-0216
Practice Address - Street 1:150 BURNETTS WAY STE 100
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8168
Practice Address - Country:US
Practice Address - Phone:757-547-5145
Practice Address - Fax:757-539-7488
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103652363A00000X
VA0110003872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2756985Medicare PIN
NCP78303Medicare UPIN