Healthcare Provider Details

I. General information

NPI: 1265690549
Provider Name (Legal Business Name): RICHARD STOCKTON WEEDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 GREEN AVE
LAWRENCEVILLE NJ
08648-1623
US

IV. Provider business mailing address

45 GREEN AVE
LAWRENCEVILLE NJ
08648-1623
US

V. Phone/Fax

Practice location:
  • Phone: 609-896-0890
  • Fax:
Mailing address:
  • Phone: 609-896-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number25MA02336600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: