Provider Demographics
NPI:1831199512
Name:WEITZ, TERESA L (PA-C)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:WEITZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:409 SOUTH SECOND STREET
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-397-4921
Mailing Address - Fax:717-397-7170
Practice Address - Street 1:2145 NOLL DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-7600
Practice Address - Country:US
Practice Address - Phone:717-397-4921
Practice Address - Fax:717-397-7170
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA002465L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103156984Medicaid
PA066577Medicare UPIN