Provider Demographics
NPI:1639285489
Name:SCAMARDO, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SCAMARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 NE STALLINGS DR
Mailing Address - Street 2:STE 103
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1239
Mailing Address - Country:US
Mailing Address - Phone:936-205-5801
Mailing Address - Fax:936-205-5915
Practice Address - Street 1:4848 NE STALLINGS DR
Practice Address - Street 2:STE 103
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1239
Practice Address - Country:US
Practice Address - Phone:936-205-5801
Practice Address - Fax:936-205-5915
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8379174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB133453Medicare PIN
TX0A0190Medicare PIN