Provider Demographics
NPI:1194760983
Name:STEVEN R. WEASEN
Entity type:Organization
Organization Name:STEVEN R. WEASEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEASEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-860-6100
Mailing Address - Street 1:209 FLORAL VALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5524
Mailing Address - Country:US
Mailing Address - Phone:215-860-6100
Mailing Address - Fax:215-860-1996
Practice Address - Street 1:209 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5524
Practice Address - Country:US
Practice Address - Phone:215-860-6100
Practice Address - Fax:215-860-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033733E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0826821000OtherHORIZON
PA2371871OtherAETNA US HEALTHCARE
PA0826821000OtherKEYSTONE
PA914814OtherBLUE CROSS/ BLUE SHIELD
PA2371871OtherAETNA US HEALTHCARE