Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS007533L | PA |
N | 207QA0401X | Family Doctor - Addiction Medicine | OS007533L | PA |
NPI | 1790778678 |
---|---|
Provider Name | Dr. Scott Steven Prince |
First Address | Hanover Township, PA 18706-5448 |
Second Address | Hanover Township, PA 18706-5448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 02/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01405578 | (05) | PA |
E92678 | (02) | |
OS007533L | LICENSE (01) | PA |