Individual
DR. BETH THOMAS WIEDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD.
Contact information
Practice address
4000 MEDICAL CENTER DR, SUITE 104, FAYETTEVILLE, NY 13066-6635
(315) 663-0059
(315) 663-0123
Mailing address
5112 WEST TAFT ROAD, SUITE L, LIVERPOOL, NY 13088
(315) 452-2500
(315) 452-2510
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
211782
NY
207Q00000X
Family Medicine Physician
Primary
211782.
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02158978
—
NY
Enumeration date
04/04/2006
Last updated
05/26/2023
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