MEDICARE: DR. SCOTT THOMAS RADOMSKY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	24164	AZ

General Provider Information

NPI Number	:	1033102843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT THOMAS RADOMSKY M.D.

Provider Business Mailing Address
First Line	:	105 S HOUGHTON RD STE 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85748-6732
Country	:	US
Telephone Number	:	520-438-5449
Fax Number	:	520-457-5692

Provider Business Practice Location Address
First Line	:	105 S HOUGHTON RD STE 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85748-6732
Country	:	US
Telephone Number	:	520-438-5449
Fax Number	:	520-457-5692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/28/2025

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