Healthcare Provider Details

I. General information

NPI: 1023094083
Provider Name (Legal Business Name): JENNIFER W WEIDNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 RIVERWAY PL BEDFORD COMMONS OBGYN PA
BEDFORD NH
03110-6763
US

IV. Provider business mailing address

201 RIVERWAY PL BEDFORD COMMONS OBGYN PA
BEDFORD NH
03110-6763
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-8400
  • Fax: 603-629-9346
Mailing address:
  • Phone: 603-668-8400
  • Fax: 603-629-9346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number12924
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: