Healthcare Provider Details

I. General information

NPI: 1154409472
Provider Name (Legal Business Name): SCOT R. MCKENNA, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 NORTHERN BLVD
SOUTH ABINGTON TOWNSHIP PA
18411-9025
US

IV. Provider business mailing address

631 NORTHERN BLVD
SOUTH ABINGTON TOWNSHIP PA
18411-9025
US

V. Phone/Fax

Practice location:
  • Phone: 570-340-6920
  • Fax: 570-340-6923
Mailing address:
  • Phone: 570-340-6920
  • Fax: 570-340-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOT ROBERT MCKENNA
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 570-340-6920