Provider Demographics
NPI:1720010614
Name:DAY, SCOTT R (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:DAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 NW WASHINGTON BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-6381
Mailing Address - Country:US
Mailing Address - Phone:215-662-3340
Mailing Address - Fax:215-222-8875
Practice Address - Street 1:840 NW WASHINGTON BLVD
Practice Address - Street 2:STE A
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6381
Practice Address - Country:US
Practice Address - Phone:215-662-3340
Practice Address - Fax:215-222-8875
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004652RX363A00000X, 363A00000X
PAMA055491363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0166204Medicaid