Provider Demographics
NPI:1497722862
Name:WEINSTOCK, JOANNA S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:S
Last Name:WEINSTOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 COLLEGE PKWY
Mailing Address - Street 2:FAHC WALK IN CARE CENTER
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3007
Mailing Address - Country:US
Mailing Address - Phone:802-847-7555
Mailing Address - Fax:802-847-7559
Practice Address - Street 1:790 COLLEGE PKWY
Practice Address - Street 2:FAHC WALK IN CARE CENTER
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3007
Practice Address - Country:US
Practice Address - Phone:802-847-7555
Practice Address - Fax:802-847-7559
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009836207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55407Medicare UPIN
VN2826Medicare ID - Type Unspecified