James Roger Wieferich, M.D.
Individual provider Active NPI Family Medicine Physician · Vincent, OH
NPI 1992774772 · NPPES record last updated May 11, 2012
Key facts
- NPI
- 1992774772
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 3506005 (OH)
- Practice address
- 40 White Oak Professional Ctr
Vincent, OH 45784-9117 - Phone
- (740) 678-2374
- Fax
- (740) 678-8139
- NPI assigned
- Mar 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3506005 | OH | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 3506005 | OH | Yes |
Addresses
Primary practice location
40 White Oak Professional Ctr
Vincent, OH 45784-9117
Mailing address
PO Box 449
Marietta, OH 45750-0449
Phone (740) 374-4500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0052785000 | Medicaid | WV | |
| P01019339 | Other | OH | MCR RAILROAD |
| 0790916 | Medicaid | OH | |
| 000000678794 | Other | OH | ANTHEM |
| 000000699796 | Other | OH | ANTHEM |
Other providers in Vincent, OH
- Warren Local School District
- Denise Wasson
- White Oak Pharmacy LLC
- White Oak Pharmacy LLC
- Barbara J Wieferich
- Lane Wilson
- Erica Ladawn Winter
All providers in Vincent, OH · Family Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.