Individual
MR. TIMOTHY SHAWN SCANLON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 395-8166
Mailing address
3131 NEWMARK DR STE 220, MIAMISBURG, OH 45342-5400
(937) 436-4658
(937) 436-4984
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.001117
OH
363AM0700X
Medical Physician Assistant
2540
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0078665
—
OH
Enumeration date
05/04/2006
Last updated
05/06/2020
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