Provider Demographics
NPI:1669465621
Name:SCOVELL, WILLIAM M JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:SCOVELL
Suffix:JR
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 1:2121 HUGHES DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3845
Mailing Address - Country:US
Mailing Address - Phone:419-291-2121
Mailing Address - Fax:419-479-6017
Practice Address - Street 1:2121 HUGHES DR
Practice Address - Street 2:SUITE 300
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3845
Practice Address - Country:US
Practice Address - Phone:419-291-2121
Practice Address - Fax:419-479-6017
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079388208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH17008OtherHPM
OH2246126OtherBCMH
OH7775293OtherAETNA
MI12-03688OtherUHC
OH000000203188OtherANTHEM
OH12-03664OtherUHC
OH4061OtherPHC
OH2246126Medicaid
MI000000216366OtherANTHEM
MI3505802321OtherBCBS MI
OHSC4050401Medicare ID - Type Unspecified
MI3505802321OtherBCBS MI