Provider Demographics
NPI:1497846570
Name:WEYANT, VALLERI D (PA)
Entity Type:Individual
Prefix:
First Name:VALLERI
Middle Name:D
Last Name:WEYANT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 JUMPERS HOLE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1600
Mailing Address - Country:US
Mailing Address - Phone:410-573-9191
Mailing Address - Fax:410-573-5910
Practice Address - Street 1:479 JUMPERS HOLE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-1600
Practice Address - Country:US
Practice Address - Phone:410-544-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDMD00002305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant