Provider Demographics
NPI:1578732236
Name:LUKE P SCAMARDO II MD PA
Entity Type:Organization
Organization Name:LUKE P SCAMARDO II MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCAMARDO
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:936-825-6444
Mailing Address - Street 1:501 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NAVASOTA
Mailing Address - State:TX
Mailing Address - Zip Code:77868-3001
Mailing Address - Country:US
Mailing Address - Phone:936-825-6444
Mailing Address - Fax:936-825-3340
Practice Address - Street 1:501 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-3001
Practice Address - Country:US
Practice Address - Phone:936-825-6444
Practice Address - Fax:936-825-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7502207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1280521 05Medicaid
LR26Medicare PIN