Provider Demographics
NPI:1043294903
Name:WEBER, THERESE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:MARIE
Last Name:WEBER
Suffix:
Gender:F
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 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC379752085B0100X, 2085R0204X, 2085U0001X
AL179842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051596105OtherBLUE CROSS
AL009935587Medicaid
AL051533108OtherBLUE CROSS
AL009936826Medicaid
AL107202Medicaid
MS04334392Medicaid
AL051533106OtherBLUE CROSS
AL051533107OtherBLUE CROSS
AL051533109OtherBLUE CROSS
AL009935357Medicaid
AL009935984Medicaid
AL051534479OtherBLUE CROSS
AL009935568Medicaid
AL009935357Medicaid
MS04334392Medicaid
AL051534479OtherBLUE CROSS
AL009936826Medicaid