MEDICARE: JOHN WESTON D.O.

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	207P00000X	Emergency Medicine Physician	224502-1	NY
2	207Q00000X	Family Medicine Physician	224502	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000153632	OTHER	NY	BLUE SHIELD

General Provider Information

NPI Number	:	1780630830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WESTON D.O.

Provider Business Mailing Address
First Line	:	571 SAINT JOSEPHS BLVD FL 2
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-3230
Country	:	US
Telephone Number	:	607-271-2050
Fax Number	:	607-873-1244

Provider Business Practice Location Address
First Line	:	200 MADISON AVE FL 3
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-3219
Country	:	US
Telephone Number	:	607-734-1581
Fax Number	:	607-734-0972

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	12/01/2020

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Directions to “ JOHN WESTON D.O.” Practice Location

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