Provider Demographics
NPI:1669445540
Name:SCHUCKER, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:SCHUCKER
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 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1189667OtherCIGNA
PA2179021000OtherAMERIHEALTH
PAOB#000000258949OtherUNISON
PA2179021000OtherINDEPENDENCE BLUE CROSS
PA50082759OtherCAPITAL BLUE CROSS
PANON HMO# 7046194OtherAETNA
PA0019695630006Medicaid
PAPCP# 000000150341OtherUNISON
PA001489233OtherHIGHMARK BLUE SHIELD
PAGYN-ID# P006243OtherGATEWAY
PA20026962OtherMERCY
PAP00068077OtherRAILROAD MEDICARE
PAHMO 3962520OtherAETNA
PA0019695630006Medicaid