Healthcare Provider Details

I. General information

NPI: 1295723294
Provider Name (Legal Business Name): JOANNE B WEIDHAAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 YORK ST HUNTER BUILDING, 1ST FL
NEW HAVEN CT
06510-3221
US

IV. Provider business mailing address

15 YORK ST HUNTER BUILDING, 1ST FL
NEW HAVEN CT
06510-3221
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-4344
  • Fax: 203-737-1281
Mailing address:
  • Phone: 203-688-4344
  • Fax: 203-737-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number042328
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: