Basic Information
Provider Information
NPI: 1003013988
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEISS
FirstName: DANIEL
MiddleName: MICHAEL
NamePrefix: MR.
NameSuffix: I
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 409 S 2ND ST STE 2F
Address2:  
City: HARRISBURG
State: PA
PostalCode: 171041612
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 503 N 21ST ST
Address2:  
City: CAMP HILL
State: PA
PostalCode: 17011
CountryCode: US
TelephoneNumber: 7177632100
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/02/2007
LastUpdateDate: 06/12/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XOA004120PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

ID Information
IDTypeStateIssuerDescription
5014982001PACBCOTHER
871262201PACIGNAOTHER
10328951405PA MEDICAID
100301398801 MEDICARE IDENTIFICATION NUMBEROTHER


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