Healthcare Provider Details

I. General information

NPI: 1982662524
Provider Name (Legal Business Name): SCOTT DOUGLAS MUIR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ALLIANCE DR SUITE 10
HAZLETON PA
18202-3234
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-6450
  • Fax: 570-501-6436
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS007301L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier078576
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHMO
# 2
Identifier001459247-0004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier01459247
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: