Provider Demographics
NPI:1316055163
Name:ALBERT J. WEISBROT M.D., INC
Entity type:Organization
Organization Name:ALBERT J. WEISBROT M.D., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEISBROT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-770-0330
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2389320Medicaid
OH2389320Medicaid
AL9206811Medicare PIN