MEDICARE: MR. ANDREW J. WEGMAN L.AC. DIPL.AC.

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	171100000X	Acupuncturist	50	NH
2	171100000X	Acupuncturist	206423	MA

General Provider Information

NPI Number	:	1861452021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW J. WEGMAN L.AC. DIPL.AC.

Provider Business Mailing Address
First Line	:	726 BEDFORD RD
Second Line	:
City	:	NEW BOSTON
State	:	NH
Zip	:	03070-5113
Country	:	US
Telephone Number	:	617-592-0334
Fax Number	:

Provider Business Practice Location Address
First Line	:	769 S MAIN ST
Second Line	:	C/O NEW ERA MEDICINE
City	:	MANCHESTER
State	:	NH
Zip	:	03102-5166
Country	:	US
Telephone Number	:	603-622-8665
Fax Number	:	603-622-9735

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/08/2007

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