Provider Demographics
NPI:1053544387
Name:WEAVER, MARISSA A (PA-C)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:A
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2895 HAMILTON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6172
Mailing Address - Country:US
Mailing Address - Phone:610-435-8986
Mailing Address - Fax:610-435-8307
Practice Address - Street 1:2895 HAMILTON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6172
Practice Address - Country:US
Practice Address - Phone:610-435-8986
Practice Address - Fax:610-435-8307
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2010-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA054108363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical