1831483635 NPI number — CARL B WEISS MD PC

Table of content: (NPI 1831483635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831483635 NPI number — CARL B WEISS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARL B WEISS MD PC
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:
1831483635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5711 CHAMBERLAYNE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23227-2415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-262-6900
Provider Business Mailing Address Fax Number:
804-266-3530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8220 MEADOWBRIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
MECHANICSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23116-2336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-568-7240
Provider Business Practice Location Address Fax Number:
804-266-3530
Provider Enumeration Date:
06/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WEISS
Authorized Official First Name:
CARL
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
804-789-8600

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  0101242939 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: VV20929952 . This is a "MEDICARE PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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