Healthcare Provider Details

I. General information

NPI: 1508921362
Provider Name (Legal Business Name): PITTSBURGH DERMATOLOGY & SKIN CANCER CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 MOSSIDE BLVD SUITE 105
MONROEVILLE PA
15146-2743
US

IV. Provider business mailing address

2790 MOSSIDE BLVD SUITE 105
MONROEVILLE PA
15146-2743
US

V. Phone/Fax

Practice location:
  • Phone: 412-372-2277
  • Fax: 412-373-2307
Mailing address:
  • Phone: 412-372-2277
  • Fax: 412-373-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY GEORGE WEAVER
Title or Position: PRESIDENT, OWNER
Credential: D.O.
Phone: 412-372-2277