MEDICARE: DR. SCOTT J WIESENBERGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MD038866	DC
2	207L00000X	Anesthesiology Physician	0101247880	VA
3	207L00000X	Anesthesiology Physician	D0070972	MD

General Provider Information

NPI Number	:	1811030695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT J WIESENBERGER MD

Provider Business Mailing Address
First Line	:	14907 MICHELE DR
Second Line	:
City	:	GLENELG
State	:	MD
Zip	:	21737-9419
Country	:	US
Telephone Number	:	954-594-4950
Fax Number	:

Provider Business Practice Location Address
First Line	:	4330 E WEST HWY
Second Line	:	SUITE 1100
City	:	BETHESDA
State	:	MD
Zip	:	20814-4408
Country	:	US
Telephone Number	:	301-986-8010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	01/07/2016

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