1528089489 NPI number — DR. PETER EDWARD WEIMERSHEIMER M.D.

Table of content: DR. PETER EDWARD WEIMERSHEIMER M.D. (NPI 1528089489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528089489 NPI number — DR. PETER EDWARD WEIMERSHEIMER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEIMERSHEIMER
Provider First Name:
PETER
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528089489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2859 LINCOLN HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HINESBURG
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05461-9671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 COLCHESTER AVE
Provider Second Line Business Practice Location Address:
FAHC, EMERGENCY SERVICES
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05401-1473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-847-3982
Provider Business Practice Location Address Fax Number:
802-847-5963
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E01982576 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0VN2034 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30200612 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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