Healthcare Provider Details

I. General information

NPI: 1447417472
Provider Name (Legal Business Name): MATTHEW D. WEAVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 WATER ST
WISCASSET ME
04578-4134
US

IV. Provider business mailing address

PO BOX 351
WISCASSET ME
04578-0351
US

V. Phone/Fax

Practice location:
  • Phone: 207-882-6008
  • Fax: 207-882-7803
Mailing address:
  • Phone: 207-882-6008
  • Fax: 207-882-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD19169
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: