Healthcare Provider Details

I. General information

NPI: 1831123306
Provider Name (Legal Business Name): ANDREW D SCALA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 PLEASANT ST
CONCORD NH
03301-2551
US

IV. Provider business mailing address

264 PLEASANT ST
CONCORD NH
03301-2551
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-3368
  • Fax: 603-724-2581
Mailing address:
  • Phone: 603-224-3368
  • Fax: 603-724-2581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0050P
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: