Provider Demographics
NPI:1053522813
Name:SCADUTO, ALLISON WAGNER (PA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:WAGNER
Last Name:SCADUTO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7701 GREENBELT RD
Mailing Address - Street 2:STE 504
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-6525
Mailing Address - Country:US
Mailing Address - Phone:410-384-9311
Mailing Address - Fax:410-384-9433
Practice Address - Street 1:7701 GREENBELT RD
Practice Address - Street 2:SUITE 504
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2037
Practice Address - Country:US
Practice Address - Phone:301-345-7375
Practice Address - Fax:301-345-7269
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002937363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0002937OtherMD LICENSE
MDMW1236264OtherDEA