Provider Demographics
NPI:1932326311
Name:WEICH, MARION M (PA-C)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:M
Last Name:WEICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 N SCOTTSDALE RD
Mailing Address - Street 2:STE 336
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5650
Mailing Address - Country:US
Mailing Address - Phone:480-646-8444
Mailing Address - Fax:480-646-8445
Practice Address - Street 1:1810 S CRISMON RD STE 191
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3900
Practice Address - Country:US
Practice Address - Phone:480-393-0575
Practice Address - Fax:480-704-4019
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3479363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ305637Medicaid
AZ305637Medicaid