Provider Demographics
NPI:1326622713
Name:WEBER, CAROLYN (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PETERS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7685
Mailing Address - Country:US
Mailing Address - Phone:717-627-7687
Mailing Address - Fax:717-627-7688
Practice Address - Street 1:432 CLOVERLEAF RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-9320
Practice Address - Country:US
Practice Address - Phone:717-544-6350
Practice Address - Fax:717-544-6353
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062438363AS0400X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical