MEDICARE: SUSAN D SCARLA 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	207Q00000X	Family Medicine Physician	13951	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477510147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN D SCARLA MD

Provider Business Mailing Address
First Line	:	2251 N 32ND ST LOT 22
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-2445
Country	:	US
Telephone Number	:	480-924-9615
Fax Number	:	480-833-0210

Provider Business Practice Location Address
First Line	:	5656 S POWER RD
Second Line	:
City	:	HIGLEY
State	:	AZ
Zip	:	85236-5421
Country	:	US
Telephone Number	:	480-840-3733
Fax Number	:	480-969-6132

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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