MEDICARE: DR. WEEZA MATTHIAS M.D.

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	207Q00000X	Family Medicine Physician	016622	ME

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00152138	OTHER	ME	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	047654	OTHER	ME	ANTHEM STAR NUMBER

General Provider Information

NPI Number	:	1851397202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WEEZA MATTHIAS M.D.

Provider Business Mailing Address
First Line	:	78 RIDGEWOOD DR
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-2652
Country	:	US
Telephone Number	:	207-947-0768
Fax Number	:	207-945-9705

Provider Business Practice Location Address
First Line	:	78 RIDGEWOOD DR
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-2652
Country	:	US
Telephone Number	:	207-947-0768
Fax Number	:	207-945-9705

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. WEEZA MATTHIAS M.D.” Practice Location

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