1043305683 NPI number — DR. BRIAN H WEISS MD

Table of content: DR. BRIAN H WEISS MD (NPI 1043305683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043305683 NPI number — DR. BRIAN H WEISS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISS
Provider First Name:
BRIAN
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1043305683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W 80TH AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46410-7184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-791-9785
Provider Business Mailing Address Fax Number:
219-791-9787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 WEST 80TH AVE.
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-6258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-791-9785
Provider Business Practice Location Address Fax Number:
219-791-9787
Provider Enumeration Date:
10/03/2006

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: 207Q00000X , with the licence number:  01024744 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080144835 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200000310 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com