Provider Demographics
NPI:1396112926
Name:WEIMER, CONDA JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:CONDA
Middle Name:JOSEPH
Last Name:WEIMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 CALVARY LN
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-7937
Mailing Address - Country:US
Mailing Address - Phone:814-243-0521
Mailing Address - Fax:
Practice Address - Street 1:655 E DUBOIS AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3605
Practice Address - Country:US
Practice Address - Phone:814-371-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057768363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical