Provider Demographics
NPI:1134156508
Name:SCALERA, KENNETH P (DO PHARMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:P
Last Name:SCALERA
Suffix:
Gender:M
Credentials:DO PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3127
Mailing Address - Country:US
Mailing Address - Phone:508-775-5011
Mailing Address - Fax:508-775-9754
Practice Address - Street 1:27 PARK ST
Practice Address - Street 2:CAPE COD HOSPITAL ANESTHESIA DEPT
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-771-1800
Practice Address - Fax:508-790-4674
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA79250207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3123731Medicaid
J14521Medicare ID - Type Unspecified
MA3123731Medicaid