Provider Demographics
NPI:1598729691
Name:WEIGEL, JOHN M (MS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:WEIGEL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 WILLOW STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584
Mailing Address - Country:US
Mailing Address - Phone:717-464-1450
Mailing Address - Fax:717-464-0890
Practice Address - Street 1:2421 WILLOW STREET PIKE
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584
Practice Address - Country:US
Practice Address - Phone:717-464-1450
Practice Address - Fax:717-464-0890
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005591L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWE581438Medicare ID - Type Unspecified
R07447Medicare UPIN