Provider Demographics
NPI:1831133602
Name:SCOTT M. SACKMAN DO PC
Entity Type:Organization
Organization Name:SCOTT M. SACKMAN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-250-1933
Mailing Address - Street 1:5201 WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2932
Mailing Address - Country:US
Mailing Address - Phone:610-250-1933
Mailing Address - Fax:610-250-8832
Practice Address - Street 1:5201 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2932
Practice Address - Country:US
Practice Address - Phone:610-250-1933
Practice Address - Fax:610-250-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D60752Medicare UPIN