Provider Demographics
NPI:1104946037
Name:SCOTT A. NAEGELE, MD, PLLC
Entity type:Organization
Organization Name:SCOTT A. NAEGELE, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NAEGELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-344-8368
Mailing Address - Street 1:830 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3389
Mailing Address - Country:US
Mailing Address - Phone:304-344-8368
Mailing Address - Fax:304-342-8938
Practice Address - Street 1:830 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3389
Practice Address - Country:US
Practice Address - Phone:304-344-8368
Practice Address - Fax:304-342-8938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17050207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0092820000Medicaid
WV0092820000Medicaid
WVSC4014741Medicare ID - Type UnspecifiedMEDICARE