Provider Demographics
NPI:1841269982
Name:MCKENNA, SCOT R (MD, PC)
Entity type:Individual
Prefix:
First Name:SCOT
Middle Name:R
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 NORTHERN BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9025
Mailing Address - Country:US
Mailing Address - Phone:570-340-6920
Mailing Address - Fax:570-340-6923
Practice Address - Street 1:631 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9025
Practice Address - Country:US
Practice Address - Phone:570-340-6920
Practice Address - Fax:570-340-6923
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054788-L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2159444OtherAETNA
PA0017435930003Medicaid
PA518350OtherBLUE CROSS BLUE SHIELD
PA51516OtherGEISINGER
PA518350OtherBLUE CROSS BLUE SHIELD
PA518350OtherBLUE CROSS BLUE SHIELD
PA808615OtherFIRTS PRIORITY