Provider Demographics
NPI:1720292600
Name:IWASHYNA, SCOTT JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JAMES
Last Name:IWASHYNA
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 1:5408 BEWDLEY RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2108
Mailing Address - Country:US
Mailing Address - Phone:804-475-2637
Mailing Address - Fax:
Practice Address - Street 1:9606 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6027
Practice Address - Country:US
Practice Address - Phone:804-740-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010124732208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics