Provider Demographics
NPI:1366516726
Name:SCOTT, ALBERT J (EDD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N HERMITAGE RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3225
Mailing Address - Country:US
Mailing Address - Phone:724-342-2330
Mailing Address - Fax:724-342-2330
Practice Address - Street 1:609 N HERMITAGE RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3225
Practice Address - Country:US
Practice Address - Phone:724-342-2330
Practice Address - Fax:724-342-2330
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003198L103G00000X
OH4260103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR05884Medicare UPIN
PA066342Medicare ID - Type Unspecified