Healthcare Provider Details

I. General information

NPI: 1700867843
Provider Name (Legal Business Name): SCOTT THOMAS WINGET PSY. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MONTEVUE LN
FREDERICK MD
21702-8214
US

IV. Provider business mailing address

6765 COVENANT CT
FREDERICK MD
21702-5813
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-1029
  • Fax: 301-631-3111
Mailing address:
  • Phone: 301-668-5860
  • Fax: 301-695-9694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2876
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: