Provider Demographics
NPI:1023071990
Name:WEAVER, JEFFREY J (PHYSICIANS ASSISTANT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:WEAVER
Suffix:
Gender:M
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-2663
Mailing Address - Country:US
Mailing Address - Phone:724-322-6527
Mailing Address - Fax:814-443-3214
Practice Address - Street 1:126 E CHURCH ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2271
Practice Address - Country:US
Practice Address - Phone:814-443-1281
Practice Address - Fax:814-443-3214
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050959363AS0400X
PAOA00970363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP23223Medicare UPIN
PA058375Medicare ID - Type UnspecifiedMEDICARE