Provider Demographics
NPI:1154500122
Name:FRED WEILAND MD, INC
Entity Type:Organization
Organization Name:FRED WEILAND MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-781-1291
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-0897
Mailing Address - Country:US
Mailing Address - Phone:916-781-1291
Mailing Address - Fax:916-663-9912
Practice Address - Street 1:1 MEDICAL PLAZA DR
Practice Address - Street 2:ATT NUCLEAR MEDICINE
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3037
Practice Address - Country:US
Practice Address - Phone:916-781-1291
Practice Address - Fax:916-663-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39050207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G390500Medicaid
CAZZZ06047ZMedicare PIN
CA00G390500Medicaid