Provider Demographics
NPI:1356540249
Name:DAFFNER, SCOTT D (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:DAFFNER
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:PO BOX 9196
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9196
Mailing Address - Country:US
Mailing Address - Phone:304-293-2779
Mailing Address - Fax:304-293-7042
Practice Address - Street 1:1 STADIUMDRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-293-2779
Practice Address - Fax:304-293-7042
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426061207X00000X
CAA99117207X00000X
WV23302207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810013082Medicaid
WV3810013082Medicaid