Healthcare Provider Details

I. General information

NPI: 1518950435
Provider Name (Legal Business Name): TIMOTHY J WEIBEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PEACH ST SUITE 300
ERIE PA
16507-1423
US

IV. Provider business mailing address

100 PEACH ST SUITE 300
ERIE PA
16507-1423
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-1851
  • Fax: 814-456-0541
Mailing address:
  • Phone: 814-459-1851
  • Fax: 814-456-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD049545L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: