Basic Information
| Provider Information | |||||||||
| NPI: | 1952302119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEISS | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172677164 | ||||||||
| FaxNumber: | 7172677414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | OS007692L | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 050086722 | 01 | PA | RAILROAD MEDICARE | OTHER | 2115432 | 01 | PA | MAMSI | OTHER | 0012836710004 | 05 | PA | MEDICAID | 25-1716306 | 01 | PA | INFORMED | OTHER | OS007692L | 01 | PA | LICENSE | OTHER | 1311006 | 01 | PA | FIRST HEALTH | OTHER | 1541400 | 01 | PA | GATEWAY | OTHER | 4272579 | 01 | PA | AETNA NON-HMO | OTHER | 50073149 | 01 | PA | CAPITAL BLUECROSS | OTHER | PEARL PROVIDER | 01 | PA | HEALTH AMERICA | OTHER | 1007307260036 | 01 | PA | MEDICAID GROUP # | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 050514 | 01 | PA | MEDICARE GROUP # | OTHER | 137150 | 01 | PA | UNISON | OTHER | 1991659 | 01 | PA | HIGHMARK BLUESHIELD | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 3832690 | 01 | PA | AETNA HMO | OTHER | BW1706475 | 01 | PA | DEA | OTHER | 120420412 | 01 | PA | DEPT OF LABOR | OTHER |