Provider Demographics
NPI:1306876628
Name:AGNEW, SCOTT M (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:AGNEW
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 1:901 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5008
Mailing Address - Country:US
Mailing Address - Phone:330-726-3000
Mailing Address - Fax:330-726-2612
Practice Address - Street 1:901 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5008
Practice Address - Country:US
Practice Address - Phone:330-726-3000
Practice Address - Fax:330-726-2612
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH114322OtherUNITED HEALTHCARE
OH264950OtherHEALTH ASSURANCE
341341025031OtherCARESOURCE
OH0240135Medicaid
000000373153OtherANTHEM BC/BS
P00250077OtherRAILROAD MEDICARE
OHQ015182OtherHOMETOWN
OHZ51970OtherSUMMACARE
OHF37420Medicare UPIN
OH114322OtherUNITED HEALTHCARE