MEDICARE: DR. STEPHEN JACOB WEEDON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	51452	MA

General Provider Information

NPI Number	:	1649214743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JACOB WEEDON M.D.

Provider Business Mailing Address
First Line	:	116 MAIN ST
Second Line	:	P.O. BOX 478
City	:	WESTMINSTER
State	:	MA
Zip	:	01473-1444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 MAIN ST
Second Line	:	WESTMINSTER FAMILY PRACTICE
City	:	WESTMINSTER
State	:	MA
Zip	:	01473-1444
Country	:	US
Telephone Number	:	978-874-0535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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