Individual
AMY GLEASON WIEGANDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2621 CRANBERRY HIGHWAY, WAREHAM, MA 02571
(508) 295-4902
(508) 295-2455
Mailing address
2621 CRANBERRY HIGHWAY, WAREHAM, MA 02571
(508) 295-4902
(508) 295-2455
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
57120
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110206873
MEDICARE RAILROAD
MA
05
—
3032736
—
MA
01
—
61516
HARVARD PILGRAM
MA
01
—
754275
TUFTS HLTH PLAN
MA
Enumeration date
05/03/2006
Last updated
01/18/2008
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