Provider Demographics
NPI:1689629834
Name:SCOTT, RACHELLE A (PAC)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROOKS LN
Mailing Address - Street 2:STE 290
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3765
Mailing Address - Country:US
Mailing Address - Phone:412-729-1500
Mailing Address - Fax:412-384-2462
Practice Address - Street 1:1200 BROOKS LN
Practice Address - Street 2:STE 290
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3765
Practice Address - Country:US
Practice Address - Phone:412-729-1500
Practice Address - Fax:412-384-2462
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051416363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001195855Medicaid
1609289OtherHIGHMARK
PA001195855Medicaid
Q11917Medicare UPIN