Provider Demographics
NPI:1033180138
Name:WEISENSEE, JAMES S
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:S
Last Name:WEISENSEE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:S
Other - Last Name:WEISENSEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:154 DODDS RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002-0470
Mailing Address - Country:US
Mailing Address - Phone:724-586-9769
Mailing Address - Fax:724-353-2040
Practice Address - Street 1:706 EKASTOWN RD
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-9724
Practice Address - Country:US
Practice Address - Phone:724-353-1508
Practice Address - Fax:724-353-2040
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003532L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37248Medicare UPIN