Provider Demographics
NPI:1285608539
Name:SCULLIN, HEATHER R (DO)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:SCULLIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 KOLBE RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1611
Mailing Address - Country:US
Mailing Address - Phone:440-960-3470
Mailing Address - Fax:440-960-4678
Practice Address - Street 1:3700 KOLBE RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1611
Practice Address - Country:US
Practice Address - Phone:440-960-3470
Practice Address - Fax:440-960-4678
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006017208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3025372Medicaid
OH0236248Medicaid
OH2001569Medicaid
OH0806333Medicare PIN
G31072Medicare UPIN
OH3025372Medicaid
OH9284951Medicare PIN
OH0806332Medicare ID - Type Unspecified