Provider Demographics
NPI:1275588261
Name:WEEMAN, LYNETTE J (DO)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:J
Last Name:WEEMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:J
Other - Last Name:FAHNESTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:198 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7019
Practice Address - Country:US
Practice Address - Phone:207-777-5300
Practice Address - Fax:207-777-1276
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1711207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME107650003Medicaid
MEP01056640Medicare PIN
MEME0660Medicare PIN
MEI12002Medicare UPIN
MEME066002Medicare PIN
MEME066001Medicare PIN
ME107650003Medicaid