Provider Demographics
NPI:1649279746
Name:WEILAND, STACEY A (MD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:WEILAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 MONUMENT RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5060
Mailing Address - Country:US
Mailing Address - Phone:717-741-9344
Mailing Address - Fax:717-741-9633
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE 250
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-741-9344
Practice Address - Fax:717-741-9633
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD072946L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018597030002Medicaid
H33178Medicare UPIN
PA0018597030002Medicaid