Basic Information
| Provider Information | |||||||||
| NPI: | 1932183993 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 536003 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152535902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004756236 | ||||||||
| FaxNumber: | 8434979566 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 S 2ND ST | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171012515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434672676 | ||||||||
| FaxNumber: | 8434979566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 07/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 2007-01573 | NC | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | OS017407 | PA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 3323712 | 01 | PA | HIGHMARK BS | OTHER | 799631 | 01 | PA | MEDICARE | OTHER |