Healthcare Provider Details

I. General information

NPI: 1780682427
Provider Name (Legal Business Name): WILLIAM J WEIR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LANSDOWNE AVE
DARBY PA
19023-1200
US

IV. Provider business mailing address

51 NORTH 39TH STREET 266 WRIGHT SAUNDERS
PHILADELPHIA PA
19104-2640
US

V. Phone/Fax

Practice location:
  • Phone: 856-423-7700
  • Fax: 856-423-0823
Mailing address:
  • Phone: 215-662-8244
  • Fax: 215-274-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN276903L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: