Provider Demographics
NPI:1982307203
Name:RICHARD L WEITZEL JR MD LLC
Entity type:Organization
Organization Name:RICHARD L WEITZEL JR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-727-9490
Mailing Address - Street 1:405 NILES CORTLAND RD SE STE 201
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2460
Mailing Address - Country:US
Mailing Address - Phone:330-372-2121
Mailing Address - Fax:330-372-2120
Practice Address - Street 1:405 NILES CORTLAND RD SE STE 201
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2460
Practice Address - Country:US
Practice Address - Phone:330-372-2121
Practice Address - Fax:330-372-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty