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NPI Code Detail

MEDICARE: SYDNEY MELVIN WEDMORE MD

MEDICARE: SYDNEY MELVIN WEDMORE 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
1207R00000XInternal Medicine Physician36730MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D08051OTHERMABLUE CROSS
2714375OTHERMATUFTS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629060934
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYDNEY MELVIN WEDMORE MD
Provider Business Mailing Address
First Line : 155 SOUTH ST
Second Line :
City : ROCKPORT
State : MA
Zip : 01966-2350
Country : US
Telephone Number : 978-645-3754
Fax Number :
Provider Business Practice Location Address
First Line : 37G WHISTLESTOP MALL
Second Line :
City : ROCKPORT
State : MA
Zip : 01966-1437
Country : US
Telephone Number : 978-546-2535
Fax Number : 978-546-8053
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 11/16/2009

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