Provider Demographics
NPI:1245216001
Name:WEIBEL, DAVID CLINTON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CLINTON
Last Name:WEIBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5 ATRIUM CT
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9017
Mailing Address - Country:US
Mailing Address - Phone:570-372-9933
Mailing Address - Fax:570-372-0828
Practice Address - Street 1:3 HOSPITAL DR
Practice Address - Street 2:SUITE 306
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9362
Practice Address - Country:US
Practice Address - Phone:570-523-3900
Practice Address - Fax:570-523-3834
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD026433L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1710556Medicaid
PA1710556Medicaid