Provider Demographics
NPI:1144869694
Name:SCOTT D WISSMAN MD MPH PC
Entity type:Organization
Organization Name:SCOTT D WISSMAN MD MPH PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:301-563-9333
Mailing Address - Street 1:9601 BLACKWELL RD STE 330
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3472
Mailing Address - Country:US
Mailing Address - Phone:202-986-5563
Mailing Address - Fax:
Practice Address - Street 1:9601 BLACKWELL RD STE 300
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3472
Practice Address - Country:US
Practice Address - Phone:301-563-9333
Practice Address - Fax:240-800-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty