Healthcare Provider Details

I. General information

NPI: 1104039833
Provider Name (Legal Business Name): MATTHEW A WEITZEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 NEW HOLLAND AVENUE SUITE 200
LANCASTER PA
17602-2288
US

IV. Provider business mailing address

304 N WATER ST
LANCASTER PA
17603-3374
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-4663
  • Fax: 717-544-4312
Mailing address:
  • Phone: 717-299-6371
  • Fax: 717-945-1584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD433542
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: