Provider Demographics
NPI:1023293750
Name:BARTL, SCOTT R (PAC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:BARTL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 SHAKER BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3869
Mailing Address - Country:US
Mailing Address - Phone:216-791-0017
Mailing Address - Fax:216-791-0021
Practice Address - Street 1:11201 SHAKER BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3869
Practice Address - Country:US
Practice Address - Phone:216-791-0017
Practice Address - Fax:216-791-0021
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
50002654363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical