Provider Demographics
NPI:1487606554
Name:SCUTELLA, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SCUTELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PEACH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1411
Mailing Address - Country:US
Mailing Address - Phone:814-459-1851
Mailing Address - Fax:814-452-0026
Practice Address - Street 1:100 PEACH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1411
Practice Address - Country:US
Practice Address - Phone:814-459-1851
Practice Address - Fax:814-452-0026
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038903E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA148202OtherHIGHMARK BC/BS
160024710OtherRAILROAD MEDICARE
PA0011478200010Medicaid
148202Medicare ID - Type Unspecified
E63843Medicare UPIN