Provider Demographics
NPI:1205208550
Name:CENTER FOR WEIGHT MANAGEMENT & WELLNESS
Entity Type:Organization
Organization Name:CENTER FOR WEIGHT MANAGEMENT & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-699-4225
Mailing Address - Street 1:1600 CONGRESS ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2143
Mailing Address - Country:US
Mailing Address - Phone:207-699-4225
Mailing Address - Fax:207-699-4226
Practice Address - Street 1:1600 CONGRESS ST
Practice Address - Street 2:SUITE C
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2143
Practice Address - Country:US
Practice Address - Phone:207-699-4225
Practice Address - Fax:207-699-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME12424174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty