Provider Demographics
NPI:1912096728
Name:MCNAIRY, SCOTT LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LAWRENCE
Last Name:MCNAIRY
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 1:93 WOODLAND CIRCLE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424
Mailing Address - Country:US
Mailing Address - Phone:612-819-5010
Mailing Address - Fax:
Practice Address - Street 1:WAYZATA BLVD SUITE 255
Practice Address - Street 2:
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1275
Practice Address - Country:US
Practice Address - Phone:612-273-8710
Practice Address - Fax:612-273-8727
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN229042084P0802X, 2084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNMS7077Medicare ID - Type Unspecified
MNA94714Medicare UPIN