Provider Demographics
NPI:1568462588
Name:JAEGER, SCOTT M (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:JAEGER
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 1:11 HUNTERS TRL
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-7281
Mailing Address - Country:US
Mailing Address - Phone:717-334-7681
Mailing Address - Fax:717-334-0730
Practice Address - Street 1:11 HUNTERS TRL
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7281
Practice Address - Country:US
Practice Address - Phone:717-334-7681
Practice Address - Fax:717-334-0730
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041293L2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011904560003Medicaid
PA23-2193641OtherEIN#
PA0011904560003Medicaid