Provider Demographics
NPI:1508842212
Name:SCANNELL, MICHAEL COLLINS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:COLLINS
Last Name:SCANNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 PACIFIC STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940
Mailing Address - Country:US
Mailing Address - Phone:831-206-1939
Mailing Address - Fax:831-222-3213
Practice Address - Street 1:977 PACIFIC STREET
Practice Address - Street 2:SUITE A
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-206-1939
Practice Address - Fax:831-222-3213
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75151207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G751510Medicaid
CAG751510Medicaid
CA00G751510OtherBLUE SHIELD OF CA
CAP00295929OtherRAILROAD MEDICARE
CAP01673286Medicare PIN
CAP00295929OtherRAILROAD MEDICARE
CAF45141Medicare UPIN
CA00G751510Medicaid