Healthcare Provider Details

I. General information

NPI: 1902874654
Provider Name (Legal Business Name): RONALD J WEBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 E LANCASTER AVE
WAYNE PA
19087-4220
US

IV. Provider business mailing address

427 E LANCASTER AVE
WAYNE PA
19087-4220
US

V. Phone/Fax

Practice location:
  • Phone: 610-688-8807
  • Fax: 610-688-2970
Mailing address:
  • Phone: 610-688-8807
  • Fax: 610-688-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-020316-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: