Beth T Wiedeman (NPI# 1295797462, PAC ID# 9931154408) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1295797462 |
| PAC ID by PECOS | 9931154408 |
| Professional Enrollment ID | I20050317000339 |
| Full Name | Beth T Wiedeman |
| Organization Legal Name | ST JOSEPHS MEDICAL PC |
| Address |
4104 Medical Ctr Dr Suite 104 Fayetteville NY 13066-6635 |
| Phone Number | 3156630059 |
| Gender | F |
| Credential | MD |
| Graduation Year | 1997 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 4688855844 |
| Number of Group Practice Members | 340 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 330140 | ST JOSEPH'S HOSPITAL HEALTH CENTER |
| 330115 | ONEIDA HEALTHCARE CENTER |
| 330241 | UNIVERSITY HOSPITAL S U N Y HEALTH SCIENCE CENTER |
| Address | Phone | Organization |
|---|---|---|
| 4104 Medical Ctr Dr, Suite 104, Fayetteville, NY 13066-6635 | 3156630059 | ST JOSEPHS MEDICAL PC |
| 5100 W Taft Rd, Liverpool, NY 13088-3807 | 3154522828 | ST JOSEPHS MEDICAL PC |
| 5100 W Taft Rd, Liverpool, NY 13088-4841 | ST JOSEPHS MEDICAL PC |
| Organization Legal Name | ST JOSEPHS MEDICAL PC |
| Physicians | 316 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ashley E Crumb | Nurse Practitioner | St Josephs Medical PC | 8278 Willett Pkwy, Fl 2, Baldwinsville, NY 13027-1311 |
| Megan M Wolfe | Nurse Practitioner | St Josephs Medical PC | 5100 W Taft Rd, Suite 1c, Liverpool, NY 13088-3808 |
| Brandon W Crandall | Nurse Practitioner | St Josephs Medical PC | 4103 Medical Ctr Dr, Fayetteville, NY 13066-6600 |
| Kyle Tucci | Nurse Practitioner | St Josephs Medical PC | 4507 Medical Ctr Dr, Fayetteville, NY 13066-6604 |
| Hooman Ranjbaran Jahromi | Cardiovascular Disease (cardiology) | St Josephs Medical PC | 4820 W Taft Rd, Suite 209, Liverpool, NY 13088-2806 |
| Robert M Kellman | Otolaryngology | St Josephs Medical PC | 4100 Medical Ctr Dr, Suite 117, Fayetteville, NY 13066 |
| Tucker Harris | Otolaryngology | St Josephs Medical PC | 4117 Medical Ctr Dr, Fayetteville, NY 13066-6600 |
| Michael P Gabris | Cardiovascular Disease (cardiology) | St Josephs Medical PC | 1000 E Genesee St, Suite 300, Syracuse, NY 13210-1853 |
| Dennis J Nave | Family Medicine | St Josephs Medical PC | 5586 Legionnaire Dr, Suite 1, Cicero, NY 13039-3504 |
| John P O'brien | Family Medicine | St Josephs Medical PC | 4104 Medical Ctr Dr, Suite 104, Fayetteville, NY 13066-6635 |
| Street Address |
4104 MEDICAL CTR DR SUITE 104 |
| City | FAYETTEVILLE |
| State | NY |
| Zip | 13066-6635 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| John P O'brien | Family Medicine | St Josephs Medical PC | 4104 Medical Ctr Dr, Suite 104, Fayetteville, NY 13066-6635 |
| Michael T Kernan | Family Medicine | St Josephs Medical PC | 4104 Medical Ctr Dr, Suite 104, Fayetteville, NY 13066-6635 |
| Nadine Khouzam | Family Medicine | St Josephs Medical PC | 4104 Medical Ctr Dr, Suite 104, Fayetteville, NY 13066-6635 |
| Austin Tsai | Family Medicine | St Josephs Medical PC | 4104 Medical Ctr Dr, Suite 104, Fayetteville, NY 13066-6635 |
| Matthew L Picone | Family Medicine | St Josephs Medical PC | 4104 Medical Ctr Dr, Suite 104, Fayetteville, NY 13066-6635 |
| Elizabeth H Mcnany | Family Medicine | St Josephs Medical PC | 4104 Medical Ctr Dr, Suite 104, Fayetteville, NY 13066-6635 |
| Kristen A Mcnamara | Family Medicine | St Josephs Medical PC | 4104 Medical Ctr Dr, Suite 104, Fayetteville, NY 13066-6635 |
| John L Cecconi | Family Medicine | St Josephs Medical PC | 4104 Medical Ctr Dr, Suite 104, Fayetteville, NY 13066-6635 |
| Lynne A Humphrey | Family Medicine | St Josephs Medical PC | 4104 Medical Ctr Dr, Suite 104, Fayetteville, NY 13066-6635 |
| Gerald P Edwards | Family Medicine | St Josephs Medical PC | 4104 Medical Ctr Dr, Suite 104, Fayetteville, NY 13066-6635 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Robert M Kellman | Otolaryngology | St Josephs Medical PC | 4100 Medical Ctr Dr, Suite 117, Fayetteville, NY 13066 |
| Francis J Durgin | Psychiatry | 6836 E Genesee St, Fayetteville, NY 13066-1024 | |
| Patricia G Barletta | Physician Assistant | Wellnow Urgent Care PC | 6870 E Genesee St, Fayetteville, NY 13066-1031 |
| Alyssa Bovalino | Physician Assistant | Wellnow Urgent Care PC | 6870 E Genesee St, Fayetteville, NY 13066-1031 |
| Jason E Falcone | Physician Assistant | Wellnow Urgent Care PC | 6870 E Genesee St, Fayetteville, NY 13066-1031 |
| Glenn J Gilberg | Physician Assistant | Wellnow Urgent Care PC | 6870 E Genesee St, Fayetteville, NY 13066-1031 |
| Joseph Novek | Podiatry | 6950 E Genesee St, Fayetteville, NY 13066-1036 | |
| Michael A Giordano | Chiropractic | 6858 E Genesee St, The Family Chiro Ctr, Fayetteville, NY 13066-1051 | |
| Stanton Tepfer | Optometry | Empire Vision Center Inc | 6859 E Genesee St, Fayetteville, NY 13066-1086 |
| Taryn A Bader | Physical Therapy | Onondaga Physical Therapy, LLC | 6800 E Genesee St, Fayetteville, NY 13066-1089 |
| Find all physicians in zip 13066 | |||
| City | FAYETTEVILLE |
| Zip Code | 13066 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | FAYETTEVILLE + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Beth T Wiedeman.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.