Provider Demographics
NPI:1861475196
Name:SCANLAN, EDWARD DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DENNIS
Last Name:SCANLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 W BRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5002
Mailing Address - Country:US
Mailing Address - Phone:813-681-4444
Mailing Address - Fax:813-661-8763
Practice Address - Street 1:426 W BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5002
Practice Address - Country:US
Practice Address - Phone:813-681-4444
Practice Address - Fax:813-661-8763
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1114182235OtherGROUP NPI
FL1861475196OtherNPI
FLGW208ZOtherMEDICARE PTAN #
D20870Medicare UPIN
FLP00040569Medicare PIN