Provider Demographics
NPI:1568420669
Name:WEISS, H KEITH (DO)
Entity Type:Individual
Prefix:DR
First Name:H
Middle Name:KEITH
Last Name:WEISS
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:PO BOX 70
Mailing Address - Street 2:381 RT 41
Mailing Address - City:CHRISTIANA
Mailing Address - State:PA
Mailing Address - Zip Code:17509
Mailing Address - Country:US
Mailing Address - Phone:610-593-5125
Mailing Address - Fax:610-593-2723
Practice Address - Street 1:381 RT 41
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:PA
Practice Address - Zip Code:17509
Practice Address - Country:US
Practice Address - Phone:610-593-5125
Practice Address - Fax:610-593-2723
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002802L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA010034423OtherRAILROAD MEDICARE PTAN
PA000683759Medicaid
D77379Medicare UPIN
PA000683759Medicaid