Healthcare Provider Details

I. General information

NPI: 1568420669
Provider Name (Legal Business Name): H KEITH WEISS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 RT 41
CHRISTIANA PA
17509
US

IV. Provider business mailing address

PO BOX 70 381 RT 41
CHRISTIANA PA
17509
US

V. Phone/Fax

Practice location:
  • Phone: 610-593-5125
  • Fax: 610-593-2723
Mailing address:
  • Phone: 610-593-5125
  • Fax: 610-593-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS002802L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: