Provider Demographics
NPI:1891766259
Name:SCOGGIN, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:SCOGGIN
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 1:2405 N COLUMBUS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8185
Mailing Address - Country:US
Mailing Address - Phone:740-687-9212
Mailing Address - Fax:740-687-5898
Practice Address - Street 1:2405 N COLUMBUS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8185
Practice Address - Country:US
Practice Address - Phone:740-687-9212
Practice Address - Fax:740-687-5898
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35-05-5843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0744654Medicaid
OHE30128Medicare UPIN
OH0744654Medicaid