Provider Demographics
NPI:1578826012
Name:HEALER, SCOTT C (PA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:HEALER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2510
Mailing Address - Country:US
Mailing Address - Phone:860-232-4891
Mailing Address - Fax:860-236-1016
Practice Address - Street 1:336 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2510
Practice Address - Country:US
Practice Address - Phone:860-232-4891
Practice Address - Fax:860-236-1016
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002769363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400083164Medicare PIN