Healthcare Provider Details

I. General information

NPI: 1649380890
Provider Name (Legal Business Name): JOHN A SCANLAND DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 MAIN ST
BLAKELY PA
18447-1370
US

IV. Provider business mailing address

1834 MAIN STREET
BLAKELY PA
18447-1266
US

V. Phone/Fax

Practice location:
  • Phone: 570-489-4432
  • Fax: 570-489-8083
Mailing address:
  • Phone: 570-489-4432
  • Fax: 570-489-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC002646L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0009388940002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: