Provider Demographics
NPI:1356567895
Name:WEATHERSBY, MARY E
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:WEATHERSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:WEATHERSBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:BOX 404
Mailing Address - Street 2:
Mailing Address - City:RYE BEACH
Mailing Address - State:NH
Mailing Address - Zip Code:03871
Mailing Address - Country:US
Mailing Address - Phone:603-964-6050
Mailing Address - Fax:
Practice Address - Street 1:75 PERKINS RD
Practice Address - Street 2:
Practice Address - City:RYE BEACH
Practice Address - State:NH
Practice Address - Zip Code:03871-0404
Practice Address - Country:US
Practice Address - Phone:603-964-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6583207P00000X
ME018152207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH40203716Medicaid
NHP01038055OtherRAILROAD MCARE
ME276180099Medicaid
NHRE231801Medicare PIN