Provider Demographics
NPI:1952302119
Name:WEISS, ROGER T (DO)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:T
Last Name:WEISS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-7164
Practice Address - Fax:717-267-7414
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007692L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050086722OtherRAILROAD MEDICARE
PA2115432OtherMAMSI
PA0012836710004Medicaid
PA25-1716306OtherINFORMED
PAOS007692LOtherLICENSE
PA1311006OtherFIRST HEALTH
PA1541400OtherGATEWAY
PA4272579OtherAETNA NON-HMO
PA50073149OtherCAPITAL BLUECROSS
PAPEARL PROVIDEROtherHEALTH AMERICA
PA1007307260036OtherMEDICAID GROUP #
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA050514OtherMEDICARE GROUP #
PA137150OtherUNISON
PA1991659OtherHIGHMARK BLUESHIELD
PA25-1716306OtherINTERGROUP
PA25-1716306OtherDEVON
PA25-1716306OtherMULTIPLAN/PHCS
PA3832690OtherAETNA HMO
PA120420412OtherDEPT OF LABOR
PA120420412OtherDEPT OF LABOR
PAPEARL PROVIDEROtherHEALTH AMERICA
PA050514OtherMEDICARE GROUP #