Provider Demographics
NPI:1285730077
Name:WEISBROT, ALBERT J (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:J
Last Name:WEISBROT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7451 S MASON MONTGOMERY ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040
Mailing Address - Country:US
Mailing Address - Phone:513-770-0330
Mailing Address - Fax:513-770-2106
Practice Address - Street 1:7451 S MASON MONTGOMERY ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-770-0330
Practice Address - Fax:513-770-2106
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2020-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35038648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0320487Medicaid
OH0320487Medicaid
OH0320487Medicaid