Healthcare Provider Details

I. General information

NPI: 1538162730
Provider Name (Legal Business Name): SCOTT MICHAEL NEEDLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 J ST STE 201
SACRAMENTO CA
95816-5542
US

IV. Provider business mailing address

1860 HOWE AVE STE 440
SACRAMENTO CA
95825-1098
US

V. Phone/Fax

Practice location:
  • Phone: 855-354-2242
  • Fax: 916-550-5003
Mailing address:
  • Phone: 855-354-2242
  • Fax: 916-550-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number158810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: