Provider Demographics
NPI:1891714937
Name:MARSTELLER, SCOTT G (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:G
Last Name:MARSTELLER
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 1:1100 REID PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-647-4231
Mailing Address - Fax:765-547-1414
Practice Address - Street 1:617 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-1281
Practice Address - Country:US
Practice Address - Phone:765-647-4231
Practice Address - Fax:765-547-1414
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068656A207Q00000X
CAA96225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400029221Medicare PIN
000000679063OtherANTHEM BCBS
INM400029221Medicare PIN