=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295827442
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGO L WEISHAR MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 11/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 904 SUMNEYTOWN PIKE STE 100
-----------------------------------------------------
City | LOWER GWYNEDD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19002-1321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-542-0655
-----------------------------------------------------
Fax | 215-542-1448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 904 SUMNEYTOWN PIKE STE 100
-----------------------------------------------------
City | LOWER GWYNEDD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19002-1321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-542-0655
-----------------------------------------------------
Fax | 215-542-1448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD050117L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------