MEDICARE: DR. CLIFTON G SCAGGS DPM

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	213E00000X	Podiatrist	2623	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WS1352	OTHER	NY	OXFORD ID

General Provider Information

NPI Number	:	1891760401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFTON G SCAGGS DPM

Provider Business Mailing Address
First Line	:	700 WHITE PLAINS RD
Second Line	:	SUITE 26
City	:	SCARSDALE
State	:	NY
Zip	:	10583-5063
Country	:	US
Telephone Number	:	914-472-3030
Fax Number	:	914-472-5575

Provider Business Practice Location Address
First Line	:	700 WHITE PLAINS RD
Second Line	:	SUITE 26
City	:	SCARSDALE
State	:	NY
Zip	:	10583-5063
Country	:	US
Telephone Number	:	914-472-3030
Fax Number	:	914-472-5575

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

Provider Enumeration Date	:	02/18/2006
Last Update Date	:	12/30/2011

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