Healthcare Provider Details

I. General information

NPI: 1841269982
Provider Name (Legal Business Name): SCOT R MCKENNA M.D., P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
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 FL 2
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 NumberMD054788-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: