Justin Mark Weaver, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA061373 Issued in PA

Practice address

1592 Route 739
Dingmans Ferry, PA 18328-3513

Phone

(570) 828-8000

NPI assigned

Mar 31, 2020

Last updated

Mar 31, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lehigh Valley Hospital Pocono

  dba Health Spectrum Pharmacy Services Pocono

  • Community/Retail Pharmacy
  • East Stroudsburg, PA
  • NPI 1447772868
  NPD (past)
• Lisa Pathak MD LLC

  dba Dingmans Medical

  • Primary Care Clinic/Center
  • Dingmans Ferry, PA
  • NPI 1841431418
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585612800000",
    "number": "1245868496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 EVERLY RD",
            "city": "LAKE ARIEL",
            "state": "PA",
            "postal_code": "184365730",
            "telephone_number": "973-803-6908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1592 ROUTE 739",
            "city": "DINGMANS FERRY",
            "state": "PA",
            "postal_code": "183283513",
            "telephone_number": "570-828-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "JUSTIN",
        "middle_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-31",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA005167",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA061373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teddi Sutherland
• Kayla Rose Taninies
• Tri-State Behavior Solutions LLC
• Anthony J Vigorito, DC
• Wayne Memorial Community Health Centers
• Weis Markets Inc (Weis Pharmacy 135)
• Ryan Worden
• Donna Wright
• Kelly Lynn Yawger
• Natalia Zhivkovich, OT

• Physician Assistant in Dingmans Ferry, PA
• Providers in Dingmans Ferry, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.