MEDICARE: MALCOLM S WEISS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD011046E	PA

General Provider Information

NPI Number	:	1396731766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALCOLM S WEISS M.D.

Provider Business Mailing Address
First Line	:	1295 GRAND BLVD
Second Line	:
City	:	MONESSEN
State	:	PA
Zip	:	15062-1955
Country	:	US
Telephone Number	:	724-684-7500
Fax Number	:	724-684-5744

Provider Business Practice Location Address
First Line	:	1295 GRAND BLVD
Second Line	:
City	:	MONESSEN
State	:	PA
Zip	:	15062-1955
Country	:	US
Telephone Number	:	724-684-7500
Fax Number	:	724-684-5744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	07/08/2007

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Directions to “ MALCOLM S WEISS M.D.” Practice Location

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