Provider Demographics
NPI:1215945274
Name:SCOTT, THOMAS RODGER (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RODGER
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-7500
Mailing Address - Fax:717-848-2074
Practice Address - Street 1:1601 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4630
Practice Address - Country:US
Practice Address - Phone:717-812-7500
Practice Address - Fax:717-848-2074
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039173E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02066701OtherBLUE CROSS
PA720041OtherBLUE SHIELD
PA0012454740004Medicaid
PA001245474Medicaid
PA720041OtherBLUE SHIELD
PA02066701OtherBLUE CROSS
PAP01398612Medicare PIN