Provider Demographics
NPI:1578539102
Name:SCOTT, TIMOTHY J (DPM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:SCOTT
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 1:22905 ROUTE 68
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8557
Mailing Address - Country:US
Mailing Address - Phone:814-226-0717
Mailing Address - Fax:814-226-5336
Practice Address - Street 1:22905 ROUTE 68
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8557
Practice Address - Country:US
Practice Address - Phone:814-226-0717
Practice Address - Fax:814-226-5336
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004077L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU59469Medicare UPIN
PA824554Medicare PIN