Provider Demographics
NPI:1932155645
Name:GOELLER, SCOTT A (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:GOELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-1106
Mailing Address - Country:US
Mailing Address - Phone:937-208-7100
Mailing Address - Fax:937-208-7125
Practice Address - Street 1:360 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-1106
Practice Address - Country:US
Practice Address - Phone:937-208-7100
Practice Address - Fax:937-208-7125
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.002849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0398243Medicaid
OH0464103Medicare PIN
OH0398243Medicaid
A78837Medicare UPIN