Healthcare Provider Details

I. General information

NPI: 1164468815
Provider Name (Legal Business Name): JAMES WEIDNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GROVE ST
HADDON HEIGHTS NJ
08035-1761
US

IV. Provider business mailing address

401 ROUTE 73 N STE 320
MARLTON NJ
08053-3426
US

V. Phone/Fax

Practice location:
  • Phone: 856-428-3746
  • Fax: 877-446-4094
Mailing address:
  • Phone: 856-872-7055
  • Fax: 856-504-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA06168500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: