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General NPI Number Information
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NPI Number | 1063601623
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Entity Type | Organization
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Legal Business Name | DPMSCOLLPRPA LLC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2375 WOODWARD ST STE 111N
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City | PHILADELPHIA
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State | PA
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Zip | 19115-5120
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Country | US
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Telephone | 215-676-7080
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Fax | 215-676-7802
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Provider Business Mailing Address
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Address Line | 2375 WOODWARD ST STE 111N
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City | PHILADELPHIA
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State | PA
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Zip | 19115-5120
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Country | US
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Telephone | 215-676-7080
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Fax | 215-676-7802
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA SCOLL
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Credential | DPM
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Telephone | 215-206-0297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC004133L
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License Number State | PA
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