Provider Demographics
NPI:1740392968
Name:SCOTT, JONATHAN M (PA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2619 CULVER RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-1746
Mailing Address - Country:US
Mailing Address - Phone:585-342-2410
Mailing Address - Fax:585-342-9141
Practice Address - Street 1:2619 CULVER RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-1746
Practice Address - Country:US
Practice Address - Phone:585-342-2410
Practice Address - Fax:585-342-9141
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY008801363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD6863Medicare ID - Type Unspecified
NYP96907Medicare UPIN