Provider Demographics
NPI:1689632291
Name:WEYRICH, TIMOTHY P (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:P
Last Name:WEYRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 WATERDAM PLAZA DRIVE
Mailing Address - Street 2:STE 120
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317
Mailing Address - Country:US
Mailing Address - Phone:724-942-3963
Mailing Address - Fax:724-942-4075
Practice Address - Street 1:2000 WATERDAM PLAZA DRIVE
Practice Address - Street 2:STE 120
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317
Practice Address - Country:US
Practice Address - Phone:724-942-3963
Practice Address - Fax:724-942-4075
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038060E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1102838Medicaid
F08003Medicare UPIN
PA1102838Medicaid