Provider Demographics
NPI:1316996119
Name:WIEGMAN, NELSON E (MD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:E
Last Name:WIEGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 N STATE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1297
Mailing Address - Country:US
Mailing Address - Phone:315-376-4505
Mailing Address - Fax:315-376-4259
Practice Address - Street 1:7785 N STATE ST STE 120
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1229
Practice Address - Country:US
Practice Address - Phone:315-376-4505
Practice Address - Fax:315-376-4259
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0003720207X00000X
MDD83131207X00000X
NY303847207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000301601Medicaid
DE0000301601Medicaid
D34768Medicare UPIN