Provider Demographics
NPI:1811986474
Name:WEAKLAND, SANDRA MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARIE
Last Name:WEAKLAND
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BAKER AVENUE EXTENSION
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2189
Mailing Address - Country:US
Mailing Address - Phone:978-369-5282
Mailing Address - Fax:978-369-2926
Practice Address - Street 1:54 BAKER AVENUE EXTENSION
Practice Address - Street 2:SUITE 103
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2189
Practice Address - Country:US
Practice Address - Phone:978-369-5282
Practice Address - Fax:978-369-2926
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1982213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0358177Medicaid
MA0358177Medicaid
Y70956Medicare ID - Type Unspecified