Provider Demographics
NPI:1184631384
Name:WEIGLE, PAUL E (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:WEIGLE
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:PO BOX 280
Mailing Address - Street 2:189 STORRS ROAD
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-0280
Mailing Address - Country:US
Mailing Address - Phone:860-456-1311
Mailing Address - Fax:860-423-5922
Practice Address - Street 1:189 STORRS RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-0280
Practice Address - Country:US
Practice Address - Phone:860-456-1311
Practice Address - Fax:860-423-5922
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD0114812084P0800X, 2084P0804X
CT425592084P0800X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411844OtherBLUE CHIP
UNKNOWNOtherPACIFICARE
15-30207OtherUNITED BEHAVIORAL HEALTH
RI27558-1OtherBLUE CROSS/SHIELD
740605000OtherMAGELLAN
RIPW3208Medicaid
CTPW53208Medicaid
CTPW53208Medicaid
007056638Medicare PIN