Healthcare Provider Details

I. General information

NPI: 1366012767
Provider Name (Legal Business Name): SCOTT CURRAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S MEADOW ST
ITHACA NY
14850-5377
US

IV. Provider business mailing address

740 S MEADOW ST
ITHACA NY
14850-5377
US

V. Phone/Fax

Practice location:
  • Phone: 607-319-4563
  • Fax:
Mailing address:
  • Phone: 607-319-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085009770
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008156RX
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004243A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601011766
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number026729
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: