Provider Demographics
NPI:1649380890
Name:SCANLAND, JOHN A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:SCANLAND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1266
Mailing Address - Country:US
Mailing Address - Phone:570-489-4432
Mailing Address - Fax:570-489-8083
Practice Address - Street 1:1834 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:PA
Practice Address - Zip Code:18447-1370
Practice Address - Country:US
Practice Address - Phone:570-489-4432
Practice Address - Fax:570-489-8083
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002646L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009388940002Medicaid
T27298Medicare UPIN
PA0009388940002Medicaid