Provider Demographics
NPI:1932294295
Name:WEYLMAN, LAURA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WEYLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102A COURT ST STE A
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1455
Mailing Address - Country:US
Mailing Address - Phone:802-382-0849
Mailing Address - Fax:802-382-0144
Practice Address - Street 1:102A COURT ST STE A
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1455
Practice Address - Country:US
Practice Address - Phone:802-382-0849
Practice Address - Fax:802-382-0144
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT420011554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015259Medicaid
H02298Medicare UPIN
VT1015259Medicaid