Provider Demographics
NPI:1477508000
Name:SCALZO, DAVID A (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:SCALZO
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 1:203 FOOTE AVE
Mailing Address - Street 2:
Mailing Address - City:DURYEA
Mailing Address - State:PA
Mailing Address - Zip Code:18642-1408
Mailing Address - Country:US
Mailing Address - Phone:570-457-4560
Mailing Address - Fax:570-457-4562
Practice Address - Street 1:203 FOOTE AVE
Practice Address - Street 2:
Practice Address - City:DURYEA
Practice Address - State:PA
Practice Address - Zip Code:18642-1408
Practice Address - Country:US
Practice Address - Phone:570-457-4560
Practice Address - Fax:570-457-4562
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004196L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA43293OtherGEISINGER HEALTH PLAN
PA0017229870004Medicaid
PA038773OtherPENNSYLVANIA BLUE SHIELD
PA038773OtherPENNSYLVANIA BLUE SHIELD
PA480028271Medicare PIN
PA022270R4JMedicare PIN
PA43293OtherGEISINGER HEALTH PLAN