1831135128 NPI number — ALAN WEISS M.D.

Table of content: ALAN WEISS M.D. (NPI 1831135128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831135128 NPI number — ALAN WEISS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISS
Provider First Name:
ALAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1831135128
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4135 BOARDMAN CANFIELD RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CANFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44406-9803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-286-5330
Provider Business Mailing Address Fax Number:
330-286-5396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
667 EASTLAND AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44484-4503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-841-4100
Provider Business Practice Location Address Fax Number:
330-481-4455
Provider Enumeration Date:
06/22/2006

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: 207LP2900X , with the licence number:  35-054278 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 35-054278 , 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: 050056510 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0658319 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000026288 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 11390908 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com