Provider Demographics
NPI:1497725881
Name:WEISER, MADELEINE C (MD)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:C
Last Name:WEISER
Suffix:
Gender:F
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:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-0395
Mailing Address - Country:US
Mailing Address - Phone:610-853-3737
Mailing Address - Fax:610-649-7404
Practice Address - Street 1:23 E WYNNEWOOD RD
Practice Address - Street 2:REAR BLDG
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-1909
Practice Address - Country:US
Practice Address - Phone:610-896-8009
Practice Address - Fax:610-649-7404
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024133E2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080648Medicare ID - Type Unspecified
PAD98846Medicare UPIN