Provider Demographics
NPI:1083147060
Name:WEISS, DEREK EDWARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:EDWARD
Last Name:WEISS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:313 HICKORY KNL
Mailing Address - Street 2:
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539-4391
Mailing Address - Country:US
Mailing Address - Phone:443-603-3694
Mailing Address - Fax:
Practice Address - Street 1:NAVAL MEDICAL CENTER
Practice Address - Street 2:100 BREWSTER BLVD
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547
Practice Address - Country:US
Practice Address - Phone:910-450-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant