Active NPI
Jeffrey G Weaver, DO
- Dermatology Physician
- Monroeville, PA
National Provider Identifier
1457344640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- OS004202L
- Practice address
- 2790 Mosside Blvd
Suite 105
Monroeville, PA 15146-2743 - Phone
- (412) 372-2277
- Fax
- (412) 373-2307
- NPI assigned
- Aug 24, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | OS004202L | PA | Primary |
| MOHS-Micrographic Surgery Physician | 207ND0101X | OS004202L | PA | |
| Procedural Dermatology Physician | 207NS0135X | OS004202L | PA |
Addresses
Primary practice location
2790 Mosside Blvd
Suite 105
Monroeville, PA 15146-2743
Mailing address
2790 Mosside Blvd
Suite 105
Monroeville, PA 15146-2743
Phone (412) 372-2277
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 097240 | Other | PA | BLUESHIELD |
| 0010428650006 | Medicaid | PA | |
| 070012504 | Other | PA | TRAV. MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653609600000",
"number": "1457344640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2790 MOSSIDE BLVD",
"address_2": "SUITE 105",
"city": "MONROEVILLE",
"state": "PA",
"postal_code": "151462743",
"telephone_number": "412-372-2277",
"fax_number": "412-373-2307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2790 MOSSIDE BLVD",
"address_2": "SUITE 105",
"city": "MONROEVILLE",
"state": "PA",
"postal_code": "151462743",
"telephone_number": "412-372-2277",
"fax_number": "412-373-2307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEAVER",
"first_name": "JEFFREY",
"middle_name": "G",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-24",
"last_updated": "2022-05-27",
"certification_date": "2022-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "PA",
"license": "OS004202L",
"primary": true
},
{
"code": "207ND0101X",
"taxonomy_group": "",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": "PA",
"license": "OS004202L",
"primary": false
},
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "PA",
"license": "OS004202L",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUESHIELD",
"identifier": "097240",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0010428650006",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRAV. MEDICARE",
"identifier": "070012504",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monroeville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.