Individual
MR. JUSTIN MARK WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1592 ROUTE 739, DINGMANS FERRY, PA 18328-3513
(570) 828-8000
Mailing address
336 EVERLY RD, LAKE ARIEL, PA 18436-5730
(973) 803-6908
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA061373
PA
363A00000X
Physician Assistant
OA005167
PA
Other
Enumeration date
03/31/2020
Last updated
03/31/2020
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