Provider Demographics
NPI:1851397202
Name:MATTHIAS, WEEZA (MD)
Entity Type:Individual
Prefix:DR
First Name:WEEZA
Middle Name:
Last Name:MATTHIAS
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 1:78 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2652
Mailing Address - Country:US
Mailing Address - Phone:207-947-0768
Mailing Address - Fax:207-945-9705
Practice Address - Street 1:78 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2652
Practice Address - Country:US
Practice Address - Phone:207-947-0768
Practice Address - Fax:207-945-9705
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00152138OtherRAILROAD MEDICARE
ME047654OtherANTHEM STAR NUMBER
MEP00152138OtherRAILROAD MEDICARE
MEME0916Medicare ID - Type Unspecified