Provider Demographics
NPI:1568799260
Name:WEINER, JEFFERY RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:RICHARD
Last Name:WEINER
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 1:6742 PAXSON RD
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-9658
Mailing Address - Country:US
Mailing Address - Phone:215-297-5051
Mailing Address - Fax:
Practice Address - Street 1:6742 PAXSON RD
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938-9658
Practice Address - Country:US
Practice Address - Phone:215-297-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009536E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice