Provider Demographics
NPI:1386604569
Name:DUANY, SCOTT J (PA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:DUANY
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:MOULTON
Other - Last Name:DUANY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:BMCHS PROVIDER ENROLLMENT
Mailing Address - Street 2:960 MASSACHUSETTS AVE FLR 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1200
Practice Address - Country:US
Practice Address - Phone:508-363-6134
Practice Address - Fax:508-363-7164
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1234363A00000X
MA1745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3100286Medicaid
MAAP2117Medicare ID - Type UnspecifiedMEDICARE NUMBER