Individual
COREY WEIDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
JACKSON RIVER ORTHOPEDICS, 1 ARH LANE, STE 102, LOW MOOR, VA 24457
(540) 862-6777
(540) 863-9167
Mailing address
PO BOX 457, 5 E ALVON ROAD, SUITE 7, WHITE SULPHUR SPRINGS, WV 24986-2373
(304) 536-5030
(304) 536-5051
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110840643
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001717977
BSMT
WV
01
—
200026
LUNG
—
01
—
258083
ANTHEM
VA
01
—
541839718
C&O
—
01
—
54183971800
WV WORKERS COMPENSATION
WV
01
—
541839718045
BS MOUNTAIN STATE
VA
Enumeration date
06/16/2005
Last updated
07/21/2022
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