Provider Demographics
NPI:1730440280
Name:MUCKEY, SCOTT A
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:MUCKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 GLENDOWER RD
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4555
Mailing Address - Country:US
Mailing Address - Phone:617-327-6157
Mailing Address - Fax:
Practice Address - Street 1:86 GLENDOWER RD
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-4555
Practice Address - Country:US
Practice Address - Phone:617-327-6157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program