Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD472150 | PA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | MD472150 | PA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 2011009936 | MO |
NPI | 1023396520 |
---|---|
Provider Name | Dr. Scott Walen |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2011 |
Last Update Date | 14/10/2020 |