Provider Demographics
NPI:1861452021
Name:WEGMAN, ANDREW J (LAC DIPLAC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:WEGMAN
Suffix:
Gender:M
Credentials:LAC DIPLAC
Other - Prefix:
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Mailing Address - Street 1:726 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03070-5113
Mailing Address - Country:US
Mailing Address - Phone:617-592-0334
Mailing Address - Fax:
Practice Address - Street 1:769 S MAIN ST
Practice Address - Street 2:C/O NEW ERA MEDICINE
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5166
Practice Address - Country:US
Practice Address - Phone:603-622-8665
Practice Address - Fax:603-622-9735
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH50171100000X
MA206423171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist