MEDICARE: TERRI E WEILAND PA-C

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	363AM0700X	Medical Physician Assistant	50001158	OH

General Provider Information

NPI Number	:	1336158013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI E WEILAND PA-C

Provider Business Mailing Address
First Line	:	1261 WOOSTER RD
Second Line	:	SUITE 230
City	:	MILLERSBURG
State	:	OH
Zip	:	44654-1568
Country	:	US
Telephone Number	:	330-674-3434
Fax Number	:	330-674-3731

Provider Business Practice Location Address
First Line	:	1261 WOOSTER RD
Second Line	:	SUITE 230
City	:	MILLERSBURG
State	:	OH
Zip	:	44654-1568
Country	:	US
Telephone Number	:	330-674-3434
Fax Number	:	330-674-3731

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	03/26/2013

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