Healthcare Provider Details

I. General information

NPI: 1306133475
Provider Name (Legal Business Name): WIEGANDT AND ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 CRANBERRY HWY
WAREHAM MA
02571-1004
US

IV. Provider business mailing address

2621 CRANBERRY HWY
WAREHAM MA
02571-1004
US

V. Phone/Fax

Practice location:
  • Phone: 508-295-4902
  • Fax: 508-295-2455
Mailing address:
  • Phone: 508-295-4902
  • Fax: 508-295-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number57120
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number57120
License Number StateMA

VIII. Authorized Official

Name: LIZBETH KAY ESTES
Title or Position: OFFICE MANAGER
Credential:
Phone: 508-295-4902