Provider Demographics
NPI:1912197146
Name:WEILY, WILLIAM JEFFREY (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEFFREY
Last Name:WEILY
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 825159
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5159
Mailing Address - Country:US
Mailing Address - Phone:301-933-7133
Mailing Address - Fax:704-541-0186
Practice Address - Street 1:10370 PARK RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8509
Practice Address - Country:US
Practice Address - Phone:704-542-8253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10477213E00000X
NC752213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWVB423AOtherWV MEDICARE