Provider Demographics
NPI:1740214121
Name:MCCLAIN, SCOTT RICHARD (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:RICHARD
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 MIDDLETOWN BLVD. STE. B22
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047
Mailing Address - Country:US
Mailing Address - Phone:267-201-8162
Mailing Address - Fax:267-201-8929
Practice Address - Street 1:582 MIDDLETOWN BLVD. STE B22
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:267-201-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051565363AM0700X
PAOA000930363A00000X
NJMP12730363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103191400-0001Medicaid
PA103191400-0001Medicaid
NJP00359525Medicare PIN
Q16501Medicare UPIN