Provider Demographics
NPI:1801980917
Name:AUTY, SCOTT EDWARD (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:EDWARD
Last Name:AUTY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 N MAPLE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1782
Mailing Address - Country:US
Mailing Address - Phone:856-596-0558
Mailing Address - Fax:856-596-4043
Practice Address - Street 1:73 N MAPLE AVE STE B
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1782
Practice Address - Country:US
Practice Address - Phone:856-596-0558
Practice Address - Fax:856-596-4043
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00025800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP29024Medicare UPIN