Provider Demographics
NPI:1376638163
Name:WELLS, SCOTT BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BRIAN
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:655 PARK AVE
Mailing Address - Street 2:SUITE NETC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5937
Mailing Address - Country:US
Mailing Address - Phone:212-794-3900
Mailing Address - Fax:212-794-0760
Practice Address - Street 1:655 PARK AVE
Practice Address - Street 2:SUITE NETC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5937
Practice Address - Country:US
Practice Address - Phone:212-794-3900
Practice Address - Fax:212-794-0760
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY167869208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF53976Medicare UPIN