MEDICARE: JOSEPH P WELDON MS CRS

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	103TC0700X	Clinical Psychologist	PS-006048-L	PA

General Provider Information

NPI Number	:	1912204215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH P WELDON MS CRS

Provider Business Mailing Address
First Line	:	2375 TERWOOD RD
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-5522
Country	:	US
Telephone Number	:	215-659-1495
Fax Number	:

Provider Business Practice Location Address
First Line	:	2375 TERWOOD RD
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-5522
Country	:	US
Telephone Number	:	215-659-1495
Fax Number	:

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

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	02/22/2011

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