Provider Demographics
NPI:1790778678
Name:PRINCE, SCOTT STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:STEVEN
Last Name:PRINCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W END RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18706-5448
Mailing Address - Country:US
Mailing Address - Phone:570-822-8875
Mailing Address - Fax:570-822-8873
Practice Address - Street 1:101 W END RD
Practice Address - Street 2:
Practice Address - City:HANOVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18706-5448
Practice Address - Country:US
Practice Address - Phone:570-822-8875
Practice Address - Fax:570-822-8873
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007533L207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01405578Medicaid
PAOS007533LOtherLICENSE
PR680071Medicare ID - Type Unspecified
PA01405578Medicaid