Provider Demographics
NPI:1659385318
Name:WINIECKI, SCOTT KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KENNETH
Last Name:WINIECKI
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 1:4 C NORTH AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:410-838-9142
Mailing Address - Fax:410-838-6453
Practice Address - Street 1:4 C NORTH AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-838-9142
Practice Address - Fax:410-838-6453
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053392208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H51548Medicare UPIN