Provider Demographics
NPI:1629386222
Name:GIVLER, JOHN SCOTT JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SCOTT
Last Name:GIVLER
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 FONTANA LN 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3017
Mailing Address - Country:US
Mailing Address - Phone:410-687-0000
Mailing Address - Fax:410-391-8656
Practice Address - Street 1:17 FONTANA LN STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3017
Practice Address - Country:US
Practice Address - Phone:410-687-0000
Practice Address - Fax:410-391-8656
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004325363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant