Provider Demographics
NPI:1588605091
Name:WEFERLING, MARIE E
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:WEFERLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GLEN COVE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4235
Mailing Address - Country:US
Mailing Address - Phone:207-596-6653
Mailing Address - Fax:207-594-9277
Practice Address - Street 1:4 GLEN COVE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4235
Practice Address - Country:US
Practice Address - Phone:207-596-6653
Practice Address - Fax:207-594-9277
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-106363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES31606Medicare UPIN
MEAP0413Medicare ID - Type Unspecified