Provider Demographics
NPI:1023476454
Name:EDWARD HENRY SCARPITTI, MD PA
Entity type:Organization
Organization Name:EDWARD HENRY SCARPITTI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:SCARPITTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:904-797-7272
Mailing Address - Street 1:17 SAINT JOHNS MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4331
Mailing Address - Country:US
Mailing Address - Phone:904-797-7272
Mailing Address - Fax:904-797-9119
Practice Address - Street 1:17 SAINT JOHNS MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4331
Practice Address - Country:US
Practice Address - Phone:904-797-7272
Practice Address - Fax:904-797-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-30
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24898208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59201OtherFL BLUE
FL59201OtherFL BLUE