Provider Demographics
NPI:1386635761
Name:WEAVER-AGOSTONI, JACQUELINE S (DO)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:WEAVER-AGOSTONI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1303
Mailing Address - Country:US
Mailing Address - Phone:612-623-2287
Mailing Address - Fax:412-623-6629
Practice Address - Street 1:5215 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1303
Practice Address - Country:US
Practice Address - Phone:612-623-2287
Practice Address - Fax:412-623-6629
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine