Individual
DR. THERESA MARIE WEGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
24 CARROW ST, ORCHARD PARK, NY 14127-2604
(716) 662-3443
(716) 972-0374
Mailing address
24 CARROW ST, ORCHARD PARK, NY 14127-2604
(716) 662-3443
(716) 972-0374
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
204233
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00020530902
UNIVERA HEALTHCARE)
NY
01
—
000525566002
BLUE CROS/BLUE SHEILD (HEALTH NOW)
NY
05
—
01924689
—
NY
01
—
1210624
INDEPENDENT HEALTH ASSOCIATION
NY
Enumeration date
05/01/2006
Last updated
06/26/2008
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