Provider Demographics
NPI:1184627820
Name:WEISS, CARL B (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:B
Last Name:WEISS
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 1:8405 N RUN MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2309
Mailing Address - Country:US
Mailing Address - Phone:804-789-8600
Mailing Address - Fax:804-789-8619
Practice Address - Street 1:8405 N RUN MEDICAL DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2309
Practice Address - Country:US
Practice Address - Phone:804-789-8600
Practice Address - Fax:804-789-8619
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-26
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39392207XS0106X
VA0101242939207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS620819926OtherBCBS
TN0723280001OtherPALMETTO
TN620819926OtherAETNA
VA1184627820Medicaid
TN3371161Medicaid
MS001933098Medicaid
TN620819926OtherCIGNA
VAP00615742OtherRAILROAD MEDICARE
AR110318002OtherARKANSAS MEDICAID
TN4101961OtherBCBS
MS620819926OtherBCBS
VA1184627820Medicaid
AR110318002OtherARKANSAS MEDICAID
TN3371161Medicaid