Provider Demographics
NPI:1275532079
Name:WIEMER, ROBBY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBBY
Middle Name:J
Last Name:WIEMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W CHESTER PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4400
Mailing Address - Country:US
Mailing Address - Phone:484-453-8164
Mailing Address - Fax:484-453-8291
Practice Address - Street 1:850 W CHESTER PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4400
Practice Address - Country:US
Practice Address - Phone:484-453-8164
Practice Address - Fax:484-453-8291
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004761L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00018271290002Medicaid
PA00018271290002Medicaid
PAU83896Medicare UPIN