1023003712 NPI number — DR. NANCY LOUISE WEISS M.D.

Table of content: DR. NANCY LOUISE WEISS M.D. (NPI 1023003712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023003712 NPI number — DR. NANCY LOUISE WEISS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISS
Provider First Name:
NANCY
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1023003712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 STANARD ST
Provider Second Line Business Mailing Address:
BOX 54
Provider Business Mailing Address City Name:
STANARDSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22973-3756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-985-7000
Provider Business Mailing Address Fax Number:
434-985-4993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 STANARD ST
Provider Second Line Business Practice Location Address:
BOX 54
Provider Business Practice Location Address City Name:
STANARDSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22973-3756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-985-7000
Provider Business Practice Location Address Fax Number:
434-985-4993
Provider Enumeration Date:
09/19/2005

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: 208600000X , with the licence number:  35526 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0101239874 . This is a "VIRGINIA BOARD OF REGISTRATION IN MEDICINE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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