1275077281 NPI number — ANITA M WEITENDORF PA-C

Table of content: ANITA M WEITENDORF PA-C (NPI 1275077281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275077281 NPI number — ANITA M WEITENDORF PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEITENDORF
Provider First Name:
ANITA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIXON
Provider Other First Name:
ANITA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275077281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 412503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-726-3884
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 MARSH BROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSWORTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-742-2007
Provider Business Practice Location Address Fax Number:
603-749-4605
Provider Enumeration Date:
12/09/2016

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: 363A00000X , with the licence number:  1223 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3106649 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".