Provider Demographics
NPI:1447516521
Name:EDWARD WEITZMAN DO PA
Entity type:Organization
Organization Name:EDWARD WEITZMAN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEITZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-268-3777
Mailing Address - Street 1:416 GAP NEWPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-9542
Mailing Address - Country:US
Mailing Address - Phone:610-268-3777
Mailing Address - Fax:610-268-3399
Practice Address - Street 1:416 GAP NEWPORT PIKE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:PA
Practice Address - Zip Code:19311-9542
Practice Address - Country:US
Practice Address - Phone:610-268-3777
Practice Address - Fax:610-268-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-003683-L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA686641Medicare UPIN