Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD446671 | PA |
Y | 207QS0010X | Family Doctor - Sports Medicine | MD446671 | PA |
NPI | 1255574349 |
---|---|
Provider Name | Dr. Jason Scotti |
First Address | Kingston, PA 18704-3715 |
Second Address | Kingston, PA 18704-3715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2009 |
Last Update Date | 30/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1028353330001 | (05) | PA |