MEDICARE: DR. JOHN MICHAEL SCALZONE 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	207V00000X	Obstetrics & Gynecology Physician	210773-1	NY
2	207VG0400X	Gynecology Physician	058299	PA
3	207V00000X	Obstetrics & Gynecology Physician	MD058299L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	160053538	OTHER	NM	RR MEDICARE PIN
2	CC8362	OTHER	NY	RR MEDICARE GROUP

Other Identifiers

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

General Provider Information

NPI Number	:	1801861489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL SCALZONE MD

Provider Business Mailing Address
First Line	:	40 W WELLSBORO ST
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-1411
Country	:	US
Telephone Number	:	570-662-1945
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 S MAIN ST
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-1510
Country	:	US
Telephone Number	:	570-662-2002
Fax Number	:

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	11/01/2023

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Directions to “ DR. JOHN MICHAEL SCALZONE MD” Practice Location

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