Healthcare Provider Details

I. General information

NPI: 1952717738
Provider Name (Legal Business Name): SCALIA PRIMARY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 TREMONT RD
PINE GROVE PA
17963-8629
US

IV. Provider business mailing address

35 TREMONT RD
PINE GROVE PA
17963-8629
US

V. Phone/Fax

Practice location:
  • Phone: 570-691-5277
  • Fax:
Mailing address:
  • Phone: 570-691-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS007750L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS007750L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ROBERT SCALIA
Title or Position: OWNER
Credential: M.D.
Phone: 570-691-5277