Provider Demographics
NPI:1639133234
Name:PRENGER, SCOTT ALAN (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:PRENGER
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 1:625 AFRICA RD STE 240
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9808
Mailing Address - Country:US
Mailing Address - Phone:614-508-2672
Mailing Address - Fax:614-508-2668
Practice Address - Street 1:625 AFRICA RD STE 240
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9808
Practice Address - Country:US
Practice Address - Phone:614-508-2672
Practice Address - Fax:614-508-2668
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2180189Medicaid
OH2180189Medicaid
OH4021345Medicare PIN