Provider Demographics
NPI:1730177411
Name:WEISENBURGER, RICHARD TODD (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:TODD
Last Name:WEISENBURGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:145 MEDICAL PARK LANE
Mailing Address - Street 2:SUITE J
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6663
Mailing Address - Country:US
Mailing Address - Phone:828-837-3223
Mailing Address - Fax:828-837-7706
Practice Address - Street 1:145 MEDICAL PARK LANE
Practice Address - Street 2:SUITE J
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6663
Practice Address - Country:US
Practice Address - Phone:828-837-3223
Practice Address - Fax:828-837-7706
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01919207YX0905X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD60783Medicare UPIN