MEDICARE: DR. JEFFREY MARC WEINER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS-019951-L	PA

General Provider Information

NPI Number	:	1003037292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY MARC WEINER DDS

Provider Business Mailing Address
First Line	:	3254 RED LION RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1109
Country	:	US
Telephone Number	:	215-632-1612
Fax Number	:	215-632-3221

Provider Business Practice Location Address
First Line	:	3254 RED LION RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1109
Country	:	US
Telephone Number	:	215-632-1612
Fax Number	:	215-632-3221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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