1841253028 NPI number — DR. ROGER M WEISS DO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841253028 NPI number — DR. ROGER M WEISS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISS
Provider First Name:
ROGER
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1841253028
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 WHITE POND DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44320-1127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-572-1011
Provider Business Mailing Address Fax Number:
330-572-1018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6847 N CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
RAVENNA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44266-3929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-296-8048
Provider Business Practice Location Address Fax Number:
330-296-8208
Provider Enumeration Date:
04/10/2006

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: 2084N0400X , with the licence number:  34006137W , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 054629 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000328351 . This is a "ANTHEM BLUECROSS/BLUESHEI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00140783 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 025996 . This is a "KAISER COMMERCIAL NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 91606713 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0164610 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341097565RW . This is a "SUMMACARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 729708 . This is a "BUCKEYE COMMUNITY HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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