Basic Information
| Provider Information | |||||||||
| NPI: | 1821021247 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCOTLAND PODIATRIC PC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1920 SCOTLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172645211 | ||||||||
| FaxNumber: | 7172645418 | ||||||||
| Practice Location | |||||||||
| Address1: | 1920 SCOTLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172645211 | ||||||||
| FaxNumber: | 7172645418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 09/16/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HOLDAWAY | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7172645211 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | SC003622L | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 214N | 01 | MD | MEDICARE TRAILBLAZERS | OTHER | DB4028 | 01 | PA | RAILROAD MEDICARE | OTHER |