Provider Demographics
NPI:1548366727
Name:HEARTH, SCOTT B (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:B
Last Name:HEARTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3040
Mailing Address - Country:US
Mailing Address - Phone:916-773-3376
Mailing Address - Fax:916-773-3353
Practice Address - Street 1:1535 EUREKA RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3040
Practice Address - Country:US
Practice Address - Phone:916-773-3376
Practice Address - Fax:916-773-3353
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68814207N00000X
CAA688140207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73394Medicare UPIN
CA00A688140Medicare ID - Type Unspecified