Provider Demographics
NPI:1689638520
Name:WEBER, JASON S (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:S
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:1949 MARLTON PIKE E STE 1
Practice Address - Street 2:504 WHITE HORSE PIKE
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2121
Practice Address - Country:US
Practice Address - Phone:856-424-6050
Practice Address - Fax:856-424-2943
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07744300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3Medicare PIN