Provider Demographics
NPI:1386781177
Name:SANDRA M WEAKLAND DPM,PC
Entity type:Organization
Organization Name:SANDRA M WEAKLAND DPM,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEAKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-369-5282
Mailing Address - Street 1:290 BAKER AVE
Mailing Address - Street 2:SUITE N104
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2189
Mailing Address - Country:US
Mailing Address - Phone:978-369-5282
Mailing Address - Fax:978-369-2926
Practice Address - Street 1:290 BAKER AVE
Practice Address - Street 2:SUITE N104
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2189
Practice Address - Country:US
Practice Address - Phone:978-369-5282
Practice Address - Fax:978-369-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1982213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6117250001Medicare NSC
MAU33727Medicare UPIN