Healthcare Provider Details

I. General information

NPI: 1265439608
Provider Name (Legal Business Name): SUSAN LOUISE WEBER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DUTCH RIDGE RD
BEAVER PA
15009-9727
US

IV. Provider business mailing address

1000 DUTCH RIDGE RD
BEAVER PA
15009-9727
US

V. Phone/Fax

Practice location:
  • Phone: 724-773-6403
  • Fax: 724-770-7943
Mailing address:
  • Phone: 724-773-6403
  • Fax: 724-770-7943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD038565E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: