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NPI Code Detail

MEDICARE: JOHN MICHAEL WEISENREIDER MD

MEDICARE: JOHN MICHAEL WEISENREIDER MD
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
1207R00000XInternal Medicine PhysicianMD428487PA

General Provider Information

NPI Number : 1669425831
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN MICHAEL WEISENREIDER MD
Provider Business Mailing Address
First Line : 601 PARK ST
Second Line :
City : HONESDALE
State : PA
Zip : 18431-1445
Country : US
Telephone Number : 570-251-6641
Fax Number : 570-253-8228
Provider Business Practice Location Address
First Line : 750 ROUTE 739
Second Line :
City : HAWLEY
State : PA
Zip : 18428-6058
Country : US
Telephone Number : 570-775-7100
Fax Number : 570-775-0950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 07/18/2019

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