Provider Demographics
NPI:1376517151
Name:LIM, SCOTT JIT-MENG (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JIT-MENG
Last Name:LIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2507
Mailing Address - Country:US
Mailing Address - Phone:814-836-1300
Mailing Address - Fax:814-836-1346
Practice Address - Street 1:3243 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2507
Practice Address - Country:US
Practice Address - Phone:814-836-1300
Practice Address - Fax:814-836-1346
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006153L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA412984OtherHIGHMARK BLUE SHIELD ID
PA1011067500001Medicaid
PA07003058OtherRAILROAD MEDICARE PROV ID
PA1500347OtherGATEWAY MA PROV ID
PA412984OtherHIGHMARK BLUE SHIELD ID
PA1500347OtherGATEWAY MA PROV ID