Healthcare Provider Details

I. General information

NPI: 1730523754
Provider Name (Legal Business Name): JUDAH DAVID WEATHERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2013
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKLAND DR
DERRY NH
03038-2746
US

IV. Provider business mailing address

195 MCGREGOR ST APT 427
MANCHESTER NH
03102-3709
US

V. Phone/Fax

Practice location:
  • Phone: 603-432-1500
  • Fax:
Mailing address:
  • Phone: 202-423-1983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18636
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: