Provider Demographics
NPI:1881685386
Name:WEAKLAND, PAMELA J (PA)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:J
Last Name:WEAKLAND
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:724-632-6312
Practice Address - Street 1:1152 WOOD ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419-1260
Practice Address - Country:US
Practice Address - Phone:724-938-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2011-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA002067L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007288440095Medicaid
PA014582Medicare Oscar/Certification
PAOTHOOOMedicare UPIN