Healthcare Provider Details

I. General information

NPI: 1295050748
Provider Name (Legal Business Name): SCOTT W. BERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2010
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EXCELA HEALTH DR STE 103
LATROBE PA
15650-9001
US

IV. Provider business mailing address

520 JEFFERSON AVE STE 400
JEANNETTE PA
15644-2538
US

V. Phone/Fax

Practice location:
  • Phone: 724-804-1780
  • Fax: 724-804-1779
Mailing address:
  • Phone: 724-689-1822
  • Fax: 724-522-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD453322
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: