Provider Demographics
NPI:1114956281
Name:WEKER, JONATHAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:L
Last Name:WEKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0010
Mailing Address - Country:US
Mailing Address - Phone:802-223-2266
Mailing Address - Fax:
Practice Address - Street 1:100 STATE ST
Practice Address - Street 2:SUITE 245
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3099
Practice Address - Country:US
Practice Address - Phone:802-223-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-00082312084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT42-0008231OtherMEDICAL LICENSE
VT0009881Medicaid
VT0009881Medicaid
VT42-0008231OtherMEDICAL LICENSE