Provider Demographics
NPI:1871603316
Name:BERLIN, SCOTT A (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:BERLIN
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 1:6375 MERCURY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-5282
Mailing Address - Country:US
Mailing Address - Phone:717-620-2500
Mailing Address - Fax:717-620-2511
Practice Address - Street 1:6375 MERCURY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-5282
Practice Address - Country:US
Practice Address - Phone:717-620-2500
Practice Address - Fax:717-620-2511
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001380L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant