Provider Demographics
NPI:1922333996
Name:WIENER, SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:WIENER
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 1:305 111TH AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8361
Mailing Address - Country:US
Mailing Address - Phone:206-785-1015
Mailing Address - Fax:206-785-1023
Practice Address - Street 1:305 111TH AVE NE STE B
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8361
Practice Address - Country:US
Practice Address - Phone:206-785-1015
Practice Address - Fax:206-785-1023
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00839072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry