Provider Demographics
NPI:1437125507
Name:WEIS, JOHN HAROLD (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAROLD
Last Name:WEIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:61 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:PA
Practice Address - Zip Code:17724-1729
Practice Address - Country:US
Practice Address - Phone:570-673-3197
Practice Address - Fax:570-673-8297
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS00372L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC9269OtherRR MEDICARE GROUP
PAGU039829OtherPA MEDICARE GROUP
PA0007678400001Medicaid
PA080176490OtherRR MEDICARE PIN
NY00552727Medicaid
PAGU039829OtherPA MEDICARE GROUP
NY00552727Medicaid