Frederick Keyser Wiese, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

6868 Issued in NH

Practice address

18 Roberts Road
Canaan, NH 03741

Phone

(603) 523-4343

Fax

(603) 523-4502

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mascoma Community Healthcare Inc

  • Dental Clinic/Center
  • Canaan, NH
  • NPI 1497298087

  NH

  Medicare reassignment NPD

Medicare fee-for-service enrollment

Enrolled in NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 21, 2019.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576886400000",
    "number": "1194739672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 ROBERTS ROAD",
            "city": "CANAAN",
            "state": "NH",
            "postal_code": "037411079",
            "telephone_number": "603-523-4343",
            "fax_number": "603-523-4502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 ROBERTS ROAD",
            "city": "CANAAN",
            "state": "NH",
            "postal_code": "03741",
            "telephone_number": "603-523-4343",
            "fax_number": "603-523-4502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESE",
        "first_name": "FREDERICK",
        "middle_name": "KEYSER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2019-12-21",
        "certification_date": "2019-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NH",
            "license": "6868",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NH",
            "license": "6868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "director@mascomahealth.org",
            "affiliation": "N",
            "address_1": "18 Roberts Road",
            "city": "Canaan",
            "state": "NH",
            "country_code": "US",
            "postal_code": "03741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Town of Canaan
• Cassandra Lynn Tucker, RN
• Elena Michelle Sutfin Vanzandt, MED, MLADC, CPS, SAP
• Courtney Vorachak
• Isabel Day Watts

• All providers in Canaan, NH
• Internal Medicine Physician in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.