Provider Demographics
NPI: | 1043214620 |
---|---|
Name: | WEIL, DEAN C (CRNA) |
Entity Type: | Individual |
Prefix: | |
First Name: | DEAN |
Middle Name: | C |
Last Name: | WEIL |
Suffix: | |
Gender: | M |
Credentials: | CRNA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1637 FAIRFIELD GREEN RD |
Mailing Address - Street 2: | |
Mailing Address - City: | RICHMOND |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23238-4065 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 804-741-3125 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1221 LEE ST |
Practice Address - Street 2: | |
Practice Address - City: | CHARLOTTESVILLE |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22908-0001 |
Practice Address - Country: | US |
Practice Address - Phone: | 434-982-4228 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-10 |
Last Update Date: | 2013-09-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0001084900 | 163W00000X |
VA | 0024084900 | 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | |
No | 163W00000X | Nursing Service Providers | Registered Nurse |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 8938920 | Medicaid | |
VA | R61266 | Medicare UPIN | |
VA | 430001769 | Medicare ID - Type Unspecified |