Healthcare Provider Details

I. General information

NPI: 1861452021
Provider Name (Legal Business Name): ANDREW J. WEGMAN L.AC. DIPL.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 S MAIN ST C/O NEW ERA MEDICINE
MANCHESTER NH
03102-5166
US

IV. Provider business mailing address

726 BEDFORD RD
NEW BOSTON NH
03070-5113
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-8665
  • Fax: 603-622-9735
Mailing address:
  • Phone: 617-592-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number50
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number206423
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: