Provider Demographics
NPI:1629060934
Name:WEDMORE, SYDNEY MELVIN (MD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MELVIN
Last Name:WEDMORE
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 1:155 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-2350
Mailing Address - Country:US
Mailing Address - Phone:978-645-3754
Mailing Address - Fax:
Practice Address - Street 1:37G WHISTLESTOP MALL
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966-1437
Practice Address - Country:US
Practice Address - Phone:978-546-2535
Practice Address - Fax:978-546-8053
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36730207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD08051OtherBLUE CROSS
MA714375OtherTUFTS
MA3134628Medicaid
MA714375OtherTUFTS
MAD08051Medicare ID - Type Unspecified