Healthcare Provider Details

I. General information

NPI: 1790778678
Provider Name (Legal Business Name): SCOTT STEVEN PRINCE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W END RD
HANOVER TOWNSHIP PA
18706-5448
US

IV. Provider business mailing address

101 W END RD
HANOVER TOWNSHIP PA
18706-5448
US

V. Phone/Fax

Practice location:
  • Phone: 570-822-8875
  • Fax: 570-822-8873
Mailing address:
  • Phone: 570-822-8875
  • Fax: 570-822-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS007533L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS007533L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: