Provider Demographics
NPI:1518901958
Name:SACKMAN, SCOTT M (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:SACKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BLACKSMITH RD STE 202
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1870
Mailing Address - Country:US
Mailing Address - Phone:610-250-1933
Mailing Address - Fax:
Practice Address - Street 1:5201 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2932
Practice Address - Country:US
Practice Address - Phone:610-250-1933
Practice Address - Fax:610-250-8832
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05054300207Y00000X
PA0S007103E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D60752Medicare UPIN
NJ071107SRGMedicare PIN
PA608883Medicare PIN