Healthcare Provider Details

I. General information

NPI: 1386781177
Provider Name (Legal Business Name): SANDRA M WEAKLAND DPM,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 BAKER AVE SUITE N104
CONCORD MA
01742-2189
US

IV. Provider business mailing address

290 BAKER AVE SUITE N104
CONCORD MA
01742-2189
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-5282
  • Fax: 978-369-2926
Mailing address:
  • Phone: 978-369-5282
  • Fax: 978-369-2926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1982
License Number StateMA

VIII. Authorized Official

Name: DR. SANDRA M WEAKLAND
Title or Position: PHYSICIAN
Credential: DPM
Phone: 978-369-5282