1780682427 NPI number — WILLIAM J WEIR CRNA

Table of content: WILLIAM J WEIR CRNA (NPI 1780682427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780682427 NPI number — WILLIAM J WEIR CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEIR
Provider First Name:
WILLIAM
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780682427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 NORTH 39TH STREET
Provider Second Line Business Mailing Address:
266 WRIGHT SAUNDERS
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19104-2640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-662-8244
Provider Business Mailing Address Fax Number:
215-274-3560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 LANSDOWNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARBY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19023-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-423-7700
Provider Business Practice Location Address Fax Number:
856-423-0823
Provider Enumeration Date:
07/07/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN276903L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00184622 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".