Provider Demographics
NPI:1447253497
Name:NAEGELE, SCOTT ALAN (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:NAEGELE
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 1:830 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 402
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3390
Mailing Address - Country:US
Mailing Address - Phone:304-344-8368
Mailing Address - Fax:304-342-8938
Practice Address - Street 1:830 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3389
Practice Address - Country:US
Practice Address - Phone:304-344-8368
Practice Address - Fax:304-342-8938
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17050207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0092820000Medicaid
WVF79963Medicare UPIN
WVSC4014741Medicare ID - Type UnspecifiedMEDICARE