MEDICARE: LARISSA ZAULYANOV SCANLAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	ME95300	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME95300	OTHER	FL	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255376711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISSA ZAULYANOV SCANLAN MD

Provider Business Mailing Address
First Line	:	13550 JOG ROAD
Second Line	:	S. D201
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-3809
Country	:	US
Telephone Number	:	561-637-2516
Fax Number	:	561-637-4657

Provider Business Practice Location Address
First Line	:	13550 JOG ROAD
Second Line	:	S. D201
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-3809
Country	:	US
Telephone Number	:	561-637-2516
Fax Number	:	561-637-4657

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	06/03/2015

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