Provider Demographics
NPI:1962419176
Name:WESTON, HEIDI ZOLLER (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ZOLLER
Last Name:WESTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-933-8681
Practice Address - Street 1:701 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3823
Practice Address - Country:US
Practice Address - Phone:610-935-7300
Practice Address - Fax:610-933-8681
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100930594Medicaid
PA100930594Medicaid
PAH83668Medicare UPIN