Provider Demographics
NPI:1457351207
Name:ROBERT J WIEMAN PHD PC
Entity type:Organization
Organization Name:ROBERT J WIEMAN PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-836-7634
Mailing Address - Street 1:1407 BETHLEHEM PIKE
Mailing Address - Street 2:THE LODGE
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1904
Mailing Address - Country:US
Mailing Address - Phone:215-836-7634
Mailing Address - Fax:215-836-7634
Practice Address - Street 1:1407 BETHLEHEM PIKE
Practice Address - Street 2:THE LODGE
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1904
Practice Address - Country:US
Practice Address - Phone:215-836-7634
Practice Address - Fax:215-836-7634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
029378OtherBLUECROSS BLUESHIELD
029378Medicare ID - Type Unspecified