Healthcare Provider Details

I. General information

NPI: 1487606554
Provider Name (Legal Business Name): MICHAEL A SCUTELLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PEACH ST SUITE 300
ERIE PA
16507-1411
US

IV. Provider business mailing address

100 PEACH ST SUITE 300
ERIE PA
16507-1411
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-1851
  • Fax: 814-452-0026
Mailing address:
  • Phone: 814-459-1851
  • Fax: 814-452-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD038903E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: