Provider Demographics
NPI:1659569143
Name:SIMON V. SCALIA M.D. LLC
Entity Type:Organization
Organization Name:SIMON V. SCALIA M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:V
Authorized Official - Last Name:SCALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-342-4142
Mailing Address - Street 1:10 OLD LYME RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3760
Mailing Address - Country:US
Mailing Address - Phone:410-342-4142
Mailing Address - Fax:410-342-1920
Practice Address - Street 1:2801 HUDSON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4998
Practice Address - Country:US
Practice Address - Phone:410-342-4142
Practice Address - Fax:410-342-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMD435MMedicare PIN