Provider Demographics
NPI:1902219702
Name:WEISS, KYLE MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:MATTHEW
Last Name:WEISS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CETRONIA RD STE 125
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9569
Mailing Address - Country:US
Mailing Address - Phone:484-526-7246
Mailing Address - Fax:866-291-6192
Practice Address - Street 1:501 CETRONIA RD STE 125
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9569
Practice Address - Country:US
Practice Address - Phone:484-526-7246
Practice Address - Fax:866-291-6192
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0198312081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine