Healthcare Provider Details

I. General information

NPI: 1740214121
Provider Name (Legal Business Name): SCOTT RICHARD MCCLAIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 MIDDLETOWN BLVD. STE B22
LANGHORNE PA
19047
US

IV. Provider business mailing address

582 MIDDLETOWN BLVD. STE. B22
LANGHORNE PA
19047
US

V. Phone/Fax

Practice location:
  • Phone: 267-201-8162
  • Fax:
Mailing address:
  • Phone: 267-201-8162
  • Fax: 267-201-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA000930
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMP12730
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA051565
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: