Provider Demographics
NPI:1205976818
Name:WEIL, DAVID EVERETT (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EVERETT
Last Name:WEIL
Suffix:
Gender:M
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 1:1900 RANDOLPH RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1122
Mailing Address - Country:US
Mailing Address - Phone:704-377-2424
Mailing Address - Fax:704-377-2687
Practice Address - Street 1:1900 RANDOLPH RD
Practice Address - Street 2:SUITE 900
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1122
Practice Address - Country:US
Practice Address - Phone:704-377-2424
Practice Address - Fax:704-377-2687
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04666363AM0700X
NC0010-02982363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1188PAMedicaid
GA186305473AMedicaid
NC1205976818Medicaid
NC1205976818Medicaid
NCNC0363HMedicare PIN
IL214881082Medicare PIN
NCNC0363EMedicare PIN
GA186305473AMedicaid
GA97WCJKXMedicare PIN
Q76634Medicare UPIN
NCNC0363GMedicare PIN