Healthcare Provider Details

I. General information

NPI: 1164401436
Provider Name (Legal Business Name): SCOTT C CONLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CLOVERLEAF RD
ELIZABETHTOWN PA
17022-9320
US

IV. Provider business mailing address

418 CLOVERLEAF RD
ELIZABETHTOWN PA
17022-9320
US

V. Phone/Fax

Practice location:
  • Phone: 717-653-1467
  • Fax: 717-653-1001
Mailing address:
  • Phone: 717-653-1467
  • Fax: 717-653-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD069993L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: