MEDICARE: JEFFREY WEDDINGTON MD

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	207N00000X	Dermatology Physician	D56329	MD

General Provider Information

NPI Number	:	1710056692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY WEDDINGTON MD

Provider Business Mailing Address
First Line	:	11701 LIVINGSTON RD
Second Line	:	302
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5104
Country	:	US
Telephone Number	:	301-292-6010
Fax Number	:	301-203-1838

Provider Business Practice Location Address
First Line	:	11701 LIVINGSTON RD
Second Line	:	302
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5104
Country	:	US
Telephone Number	:	301-292-6010
Fax Number	:	301-203-1838

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	12/09/2019

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