Provider Demographics
NPI:1154329647
Name:WEISENBERGER, GREGORY EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EUGENE
Last Name:WEISENBERGER
Suffix:
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 1:7657 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1243
Mailing Address - Country:US
Mailing Address - Phone:614-864-8500
Mailing Address - Fax:614-864-8646
Practice Address - Street 1:2300 BALTIMORE REYNOLDSBURG RD # 200
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8030
Practice Address - Country:US
Practice Address - Phone:614-627-1375
Practice Address - Fax:614-864-8646
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWE0582551Medicare ID - Type Unspecified