Provider Demographics
NPI:1922084219
Name:WEANER, SCOTT MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:WEANER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1093 COUNTRY HILLS RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-6024
Mailing Address - Country:US
Mailing Address - Phone:215-428-1689
Mailing Address - Fax:609-584-7806
Practice Address - Street 1:2275 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-2643
Practice Address - Country:US
Practice Address - Phone:609-584-8588
Practice Address - Fax:609-584-7806
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB587222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF39971Medicare UPIN