Healthcare Provider Details

I. General information

NPI: 1972062800
Provider Name (Legal Business Name): SEAN ROBERT SCANLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL PARK STE 102
WHEELING WV
26003-6390
US

IV. Provider business mailing address

20 MEDICAL PARK STE 102
WHEELING WV
26003-6390
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-6530
  • Fax:
Mailing address:
  • Phone: 304-243-6530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number36236
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: