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Individual
MATTHEW L. WIESE
Active
Individual
MATTHEW L. WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
274395
MA
2080P0203X
Pediatric Critical Care Medicine Physician
298763
NY
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
274395
MA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
298763
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
NULL
Other
Enumeration date
04/15/2015
Last updated
06/06/2023
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