Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Theodore C Weatherwax, MD

Individual provider Family Medicine Physician · NPI 1144882879

Theodore C Weatherwax, MD is an Emergency Medicine in Boston, Massachusetts. Graduated from University of New Mexico School of Medicine in 2018, 8 years ago. Practices with Sunnyside Emergency Group a Professional LLC, a 17-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Massachusetts and Washington.

Years since qualifying
8
Trained at
University of New Mexico School of Medicine
Licensed in
MA, WA
In the registry since
2019
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

55 Fruit St
Boston, MA 02114-2621
Phone: (617) 726-3557
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2209 E 32nd St, Tacoma, WA 98404-4922 — (253) 593-0232

Specialties & licences

Addiction Medicine (Family Medicine) Physician (primary) Taxonomy 207QA0401X · Licence 291350 (MA)
Family Medicine Physician Taxonomy 207Q00000X · Licence MDRE.ML.60958797 (WA)

Record details

NPI number1144882879
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 2, 2019
Last updated in NPPESNovember 23, 2022
Certification dateNovember 23, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolUNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE
Graduated 2018 (8 years in practice)
Group practice Sunnyside Emergency Group A Professional Llc — 17 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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