Provider Demographics
NPI:1811264559
Name:WEYMOUTH SURGICAL LLC
Entity type:Organization
Organization Name:WEYMOUTH SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEYMOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:603-818-8914
Mailing Address - Street 1:44 BIRCH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2752
Mailing Address - Country:US
Mailing Address - Phone:603-965-4505
Mailing Address - Fax:603-965-4063
Practice Address - Street 1:44 BIRCH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2752
Practice Address - Country:US
Practice Address - Phone:603-965-4505
Practice Address - Fax:603-965-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219696208600000X
NH12895208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30224519Medicaid
NHH07040Medicare UPIN
NHRE8897Medicare PIN