Healthcare Provider Details

I. General information

NPI: 1346343399
Provider Name (Legal Business Name): JEFFREY KARLTON WEBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 A&B LAKE STREET LAKE STREET FAMILY PRACTICE
EPHRATA PA
17522
US

IV. Provider business mailing address

136 A&B LAKE STREET
EPHRATA PA
17522
US

V. Phone/Fax

Practice location:
  • Phone: 717-721-7718
  • Fax: 717-721-7726
Mailing address:
  • Phone: 717-721-7718
  • Fax: 717-721-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD056265L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: