Provider Demographics
NPI:1497782932
Name:NANKO, RAYMOND SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:SCOTT
Last Name:NANKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-0730
Mailing Address - Country:US
Mailing Address - Phone:317-219-5409
Mailing Address - Fax:317-219-3151
Practice Address - Street 1:919 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-1554
Practice Address - Country:US
Practice Address - Phone:765-288-3276
Practice Address - Fax:765-289-2389
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045317A208VP0014X, 207Q00000X
IN08001557A111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200042680AMedicaid
IN200149200AMedicaid
IN200149200AMedicaid
G61644Medicare UPIN
IN466750Medicare PIN