MEDICARE: JEFFREY G WEAVER DO

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	207N00000X	Dermatology Physician	OS004202L	PA
2	207ND0101X	MOHS-Micrographic Surgery Physician	OS004202L	PA
3	207NS0135X	Procedural Dermatology Physician	OS004202L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	070012504	OTHER	PA	TRAV. MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	097240	OTHER	PA	BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457344640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY G WEAVER DO

Provider Business Mailing Address
First Line	:	2790 MOSSIDE BLVD
Second Line	:	SUITE 105
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-2743
Country	:	US
Telephone Number	:	412-372-2277
Fax Number	:	412-373-2307

Provider Business Practice Location Address
First Line	:	2790 MOSSIDE BLVD
Second Line	:	SUITE 105
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-2743
Country	:	US
Telephone Number	:	412-372-2277
Fax Number	:	412-373-2307

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	05/27/2022

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Directions to “ JEFFREY G WEAVER DO” Practice Location

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