Provider Demographics
NPI:1659310936
Name:SCOTT, CHARLES R JR (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:SCOTT
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 OVERLOOK LN
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2645
Mailing Address - Country:US
Mailing Address - Phone:610-940-0145
Mailing Address - Fax:
Practice Address - Street 1:305 OVERLOOK LN
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2645
Practice Address - Country:US
Practice Address - Phone:610-940-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA203829367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered