Provider Demographics
NPI:1619923331
Name:WERDEN, SCOTT A (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:WERDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WATERSIDE XING
Mailing Address - Street 2:3RD FLOOR ATTN: KAREN FRISK, CONTRACTING
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1540
Mailing Address - Country:US
Mailing Address - Phone:800-397-1095
Mailing Address - Fax:860-298-6127
Practice Address - Street 1:3440 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1837
Practice Address - Country:US
Practice Address - Phone:415-922-6767
Practice Address - Fax:415-563-0468
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG847492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG61200Medicaid
CAG61200Medicaid