MEDICARE: JOSEPH SCAMARDO M.D.

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	174400000X	Specialist	H8379	TX
2	2084N0400X	Neurology Physician	H8379	TX

General Provider Information

NPI Number	:	1639285489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH SCAMARDO M.D.

Provider Business Mailing Address
First Line	:	4848 NE STALLINGS DR
Second Line	:	STE 103
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1239
Country	:	US
Telephone Number	:	936-205-5801
Fax Number	:	936-205-5915

Provider Business Practice Location Address
First Line	:	4848 NE STALLINGS DR
Second Line	:	STE 103
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1239
Country	:	US
Telephone Number	:	936-205-5801
Fax Number	:	936-205-5915

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	03/07/2017

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