1437148590 NPI number — DANIEL WEISS MD FACP CDE

Table of content: DANIEL WEISS MD FACP CDE (NPI 1437148590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437148590 NPI number — DANIEL WEISS MD FACP CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISS
Provider First Name:
DANIEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD FACP CDE
Provider Gender Code:
M

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:
1437148590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44119-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-833-4056
Provider Business Mailing Address Fax Number:
440-833-4068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8300 TYLER BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MENTOR
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44060-4251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-266-5000
Provider Business Practice Location Address Fax Number:
440-266-5004
Provider Enumeration Date:
10/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35053498 , 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: 0626871 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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