Provider Demographics
NPI:1972593226
Name:SCAVINA, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:SCAVINA
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 1:250 DEBARTOLO PL
Mailing Address - Street 2:SUITE 2750
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-7004
Mailing Address - Country:US
Mailing Address - Phone:330-758-7703
Mailing Address - Fax:330-758-4930
Practice Address - Street 1:250 DEBARTOLO PL
Practice Address - Street 2:SUITE 2750
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-7004
Practice Address - Country:US
Practice Address - Phone:330-758-7703
Practice Address - Fax:330-758-4930
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058362207RC0000X, 207R00000X
PAMD344205L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01444576Medicaid
OH0927448Medicaid
OH0927448Medicaid
OHF55613Medicare UPIN
PA01444576Medicaid