Provider Demographics
NPI:1881858736
Name:FINN WEDMID, MYRA E (MD)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:E
Last Name:FINN WEDMID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MYRA
Other - Middle Name:
Other - Last Name:FINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:72 W JIMMIE LEEDS RD
Mailing Address - Street 2:STE 1100
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9426
Mailing Address - Country:US
Mailing Address - Phone:609-652-8316
Mailing Address - Fax:609-653-8764
Practice Address - Street 1:16 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5614
Practice Address - Country:US
Practice Address - Phone:732-968-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2479562085R0202X
NJ25MA089905002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0252921Medicaid
NJ0252921Medicaid