Provider Demographics
NPI:1477085850
Name:WESELOH, ADISON (MD)
Entity Type:Individual
Prefix:DR
First Name:ADISON
Middle Name:
Last Name:WESELOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 LOMBARD STREET
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1498
Mailing Address - Country:US
Mailing Address - Phone:215-893-2600
Mailing Address - Fax:215-893-2610
Practice Address - Street 1:1800 LOMBARD STREET
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1498
Practice Address - Country:US
Practice Address - Phone:215-893-2600
Practice Address - Fax:215-893-2610
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD473630208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation