1154536597 NPI number — PAUL D WEIDMAN, MD PLLC

Table of content: (NPI 1154536597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154536597 NPI number — PAUL D WEIDMAN, MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL D WEIDMAN, MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154536597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 PLAZA DRIVE WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST CLAIRSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43950-1540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-296-5159
Provider Business Mailing Address Fax Number:
740-296-5168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CLAIRSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43950-6700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-296-5159
Provider Business Practice Location Address Fax Number:
740-695-5168
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEIDMAN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
SOLE PROPRIETER
Authorized Official Telephone Number:
740-296-5159

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  3584922 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001706186 . This is a "BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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