MEDICARE: DISCOVER OPTIMAL HEALTHCARE

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	207QS0010X	Sports Medicine (Family Medicine) Physician	OS003505L	PA
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	208100000X	Physical Medicine & Rehabilitation Physician	OS003505L	PA

General Provider Information

NPI Number	:	1538412887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOVER OPTIMAL HEALTHCARE

Provider Business Mailing Address
First Line	:	3605 EDGMONT AVE
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-2862
Country	:	US
Telephone Number	:	610-876-6180
Fax Number	:	610-876-6130

Provider Business Practice Location Address
First Line	:	3605 EDGMONT AVE
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-2862
Country	:	US
Telephone Number	:	610-876-6180
Fax Number	:	610-876-6130

Authorized Official
Title or Position	:	OWNER
Name	:	JASON WEIGNER
Credential	:	DC
Telephone Number	:	610-876-6180

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	06/29/2022

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