MEDICARE: ELLEN T SCHOLNICOFF 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	207K00000X	Allergy & Immunology Physician	MD428339	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6K8086	OTHER	PA	MEDICARE PTAN

General Provider Information

NPI Number	:	1811935059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN T SCHOLNICOFF MD

Provider Business Mailing Address
First Line	:	PO BOX 603725
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-3725
Country	:	US
Telephone Number	:	828-575-2625
Fax Number	:	828-350-2174

Provider Business Practice Location Address
First Line	:	4212 OLD WILLIAM PENN HWY
Second Line	:
City	:	MURRYSVILLE
State	:	PA
Zip	:	15668-1901
Country	:	US
Telephone Number	:	724-837-4070
Fax Number	:	724-837-3316

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/12/2024

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