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General NPI Number Information
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NPI Number | 1174505671
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Entity Type | Individual
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Provider Name | FAITH ANN WEIDNER MD
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Gender | Female
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 421 N MAIN ST VA MEDICAL CENTER
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City | LEEDS
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State | MA
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Zip | 01053-9764
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Country | US
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Telephone | 413-584-4040
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Fax | 413-582-3054
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Provider Business Mailing Address
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Address Line | 421 N MAIN ST VA MEDICAL CENTER
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City | LEEDS
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State | MA
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Zip | 01053-9764
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Country | US
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Telephone | 413-584-4040
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Fax | 413-582-3054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 021987
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License Number State | CT
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