Provider Demographics
NPI:1104987452
Name:WEISEL FAMILY PRACTICE, PC
Entity type:Organization
Organization Name:WEISEL FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:WEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-547-7440
Mailing Address - Street 1:220 BESSEMER RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-9122
Mailing Address - Country:US
Mailing Address - Phone:724-547-7440
Mailing Address - Fax:724-547-7442
Practice Address - Street 1:220 BESSEMER RD
Practice Address - Street 2:SUITE 208
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-9122
Practice Address - Country:US
Practice Address - Phone:724-547-7440
Practice Address - Fax:724-547-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020089E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADE0458OtherRAILROAD MEDICARE
PA0007361280015Medicaid
PA096610Medicare PIN
PADE0458OtherRAILROAD MEDICARE