Healthcare Provider Details

I. General information

NPI: 1386693927
Provider Name (Legal Business Name): SCOTT A STEVENS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE ST
ERIE PA
16550-0002
US

IV. Provider business mailing address

3998 FAIR RIDGE DRIVE SUITE 320
FAIRFAX VA
22033
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-2137
  • Fax: 814-877-7049
Mailing address:
  • Phone: 703-295-9360
  • Fax: 703-766-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS012193
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: