Provider Demographics
NPI:1659426690
Name:WIEMAN, ROBERT JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:WIEMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 BETHLEHEM PIKE STE 301
Mailing Address - Street 2:THE LODGE
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1946
Mailing Address - Country:US
Mailing Address - Phone:215-836-7634
Mailing Address - Fax:215-836-7634
Practice Address - Street 1:1407 BETHLEHEM PIKE STE 301
Practice Address - Street 2:THE LODGE
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1946
Practice Address - Country:US
Practice Address - Phone:215-836-7634
Practice Address - Fax:215-836-7634
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002267L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0023671000OtherPERSONAL CHOICE
PA1783949OtherBLUE SHIELD
PA029378Medicare ID - Type UnspecifiedMEDICARE