Provider Demographics
NPI:1538418983
Name:THIELBAR, SCOTT DAVID (PA-C)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DAVID
Last Name:THIELBAR
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 1:214 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3106
Mailing Address - Country:US
Mailing Address - Phone:704-730-1228
Mailing Address - Fax:704-730-1231
Practice Address - Street 1:214 N. CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3106
Practice Address - Country:US
Practice Address - Phone:704-730-1228
Practice Address - Fax:704-730-1231
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05065363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant