=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376735522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHARINE LOPEZ WEYMOUTH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2007
-----------------------------------------------------
Last Update Date | 09/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4001 KENNETT PIKE STE 244
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19807-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-566-5020
-----------------------------------------------------
Fax | 302-300-4666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4001 KENNETT PIKE STE 244
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19807-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-566-5020
-----------------------------------------------------
Fax | 302-300-4666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | C1-0008326
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------