Wiedeman, Beth Thomas

Wiedeman, Beth Thomas is an individual health care provider with primary practice located at 4000 Medical Center Dr Suite 104, Fayetteville NY 13066-6635. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Wiedeman, Beth Thomas can be contacted via phone (315) 663-0059.

Contact Information

Primary practice address
4000 Medical Center Dr Suite 104 Fayetteville NY 13066-6635
Phone: (315) 663-0059
Fax: (315) 663-0123
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 211782 New York
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 211782. New York

Profile Details

NPI number 1295797462
LBN Legal business name Wiedeman, Beth Thomas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 4th, 2006
Last updated May 26th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295797462 NPPES
New York MEDICAID 02158978

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