Healthcare Provider Details

I. General information

NPI: 1619165867
Provider Name (Legal Business Name): SCOTT JASON PELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LOUIS DR STE 202
WARMINSTER PA
18974-2847
US

IV. Provider business mailing address

600 LOUIS DR STE 202
WARMINSTER PA
18974-2847
US

V. Phone/Fax

Practice location:
  • Phone: 215-957-5400
  • Fax: 215-957-5401
Mailing address:
  • Phone: 215-957-5400
  • Fax: 215-954-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number25MA08897600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberMD439665
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: