Provider Demographics
NPI:1457344640
Name:WEAVER, JEFFREY G (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:WEAVER
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 1:2790 MOSSIDE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2743
Mailing Address - Country:US
Mailing Address - Phone:412-372-2277
Mailing Address - Fax:412-373-2307
Practice Address - Street 1:2790 MOSSIDE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2743
Practice Address - Country:US
Practice Address - Phone:412-372-2277
Practice Address - Fax:412-373-2307
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004202L207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097240OtherBLUESHIELD
PA0010428650006Medicaid
PA070012504OtherTRAV. MEDICARE
D98635Medicare UPIN
PA097240TTSMedicare ID - Type Unspecified