Provider Demographics
NPI:1679653521
Name:WEBER, MARK D (NP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:WEBER
Suffix:
Gender:M
Credentials:NP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3401 CIVIC CENTER BLVD STE 9329
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:267-425-9300
Mailing Address - Fax:267-443-1341
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-1000
Practice Address - Fax:215-590-1415
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASP007670363LC0200X, 363LP0200X, 363LP0222X
NC5003907363LP0200X
WV62436363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001805Medicare ID - Type Unspecified
Q33748Medicare UPIN
WVWE6032591Medicare ID - Type Unspecified