Individual
AIDA E SCANLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
3445 S DIXIE DR, MORAINE, OH 45439
(937) 534-0155
(937) 534-0166
Mailing address
3445 S DIXIE DR, SUITE 100, MORAINE, OH 45439-2330
(937) 534-0155
(937) 534-0166
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50000999RX
OH
363AM0700X
Medical Physician Assistant
50000999RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
OH
Enumeration date
06/22/2016
Last updated
11/24/2020
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