Provider Demographics
NPI:1184744054
Name:MCGRATH, SCOTT (DPM)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MCGRATH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 MAIN ST REAR
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1618
Mailing Address - Country:US
Mailing Address - Phone:570-383-9720
Mailing Address - Fax:570-383-9721
Practice Address - Street 1:256 MAIN ST REAR
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1618
Practice Address - Country:US
Practice Address - Phone:570-383-9720
Practice Address - Fax:570-383-9721
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003269L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMC403404Medicare ID - Type Unspecified
PAU06534Medicare UPIN