Provider Demographics
NPI:1396740791
Name:SCALCO, STEVEN ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ANTHONY
Last Name:SCALCO
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 1:3812 RIDGELAKE DR
Mailing Address - Street 2:STE 2B
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-7233
Mailing Address - Country:US
Mailing Address - Phone:504-833-0250
Mailing Address - Fax:504-833-4596
Practice Address - Street 1:3812 RIDGELAKE DR
Practice Address - Street 2:STE 2B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-7233
Practice Address - Country:US
Practice Address - Phone:504-833-0250
Practice Address - Fax:504-833-4596
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-08-18
Deactivation Date:2006-03-31
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
LA017753207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1906921Medicaid
LA55765Medicare ID - Type Unspecified
LA1906921Medicaid