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General NPI Number Information
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NPI Number | 1447250352
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Entity Type | Individual
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Provider Name | MICHAEL JAMES SCANLON DPM
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 162 MANSFIELD AVE APT A
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City | WILLIMANTIC
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State | CT
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Zip | 06226-2062
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Country | US
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Telephone | 860-456-4250
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Fax | 860-456-3745
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Provider Business Mailing Address
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Address Line | 162 MANSFIELD AVE APT A
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City | WILLIMANTIC
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State | CT
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Zip | 06226-2062
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Country | US
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Telephone | 860-456-4250
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Fax | 860-456-3745
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 650
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License Number State | CT
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