Provider Demographics
NPI:1972999654
Name:DUTTON, WESLEY PAUL (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:PAUL
Last Name:DUTTON
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 1:8 ENFIELD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2283
Mailing Address - Country:US
Mailing Address - Phone:901-210-2640
Mailing Address - Fax:
Practice Address - Street 1:50 STANIFORD ST STE 430
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2541
Practice Address - Country:US
Practice Address - Phone:617-726-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35135657207R00000X
OH35.135657208000000X
MA2838952080B0002X, 207RB0002X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program