Provider Demographics
NPI:1316995509
Name:WEBER, FREDERICK L JR (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:L
Last Name:WEBER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 633448
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-3448
Mailing Address - Country:US
Mailing Address - Phone:513-853-4706
Mailing Address - Fax:513-853-4743
Practice Address - Street 1:10600 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-794-5600
Practice Address - Fax:513-281-1908
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046677207RI0008X
OH35-046677207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0498966Medicaid
IN200027350Medicaid
OHP00376153OtherRAILROAD MEDICARE
KY64932486Medicaid
OHP00376153OtherRAILROAD MEDICARE
OH0519326Medicare PIN
IN172430MMedicare PIN