Provider Demographics
NPI:1598944936
Name:DAVID A SCALZO D.P.M.,P.C.
Entity Type:Organization
Organization Name:DAVID A SCALZO D.P.M.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCALZO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-457-4560
Mailing Address - Street 1:203 FOOTE AVE
Mailing Address - Street 2:
Mailing Address - City:DURYEA
Mailing Address - State:PA
Mailing Address - Zip Code:18642-1408
Mailing Address - Country:US
Mailing Address - Phone:570-457-4560
Mailing Address - Fax:570-457-4562
Practice Address - Street 1:203 FOOTE AVE
Practice Address - Street 2:
Practice Address - City:DURYEA
Practice Address - State:PA
Practice Address - Zip Code:18642-1408
Practice Address - Country:US
Practice Address - Phone:570-457-4560
Practice Address - Fax:570-457-4562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004196L213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002138536OtherPENNSYLVANIA BLUE SHEILD
PA1021229540001Medicaid
PA5386OtherGEISINGER HEALTH PLAN
PA5160370001Medicare NSC
PAU73305Medicare UPIN
PA002138536OtherPENNSYLVANIA BLUE SHEILD
PA5386OtherGEISINGER HEALTH PLAN