Healthcare Provider Details

I. General information

NPI: 1114152600
Provider Name (Legal Business Name): JEFFREY A. WEIHING PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 FOREST AVE STE 301
PORTLAND ME
04103-1884
US

IV. Provider business mailing address

1250 FOREST AVE STE 301
PORTLAND ME
04103-1884
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-5753
  • Fax:
Mailing address:
  • Phone: 207-797-5753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0534
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1028
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAP2652
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: