Provider Demographics
NPI:1215021084
Name:WEISS, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
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 1:55 CAREN AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2552
Mailing Address - Country:US
Mailing Address - Phone:614-846-1527
Mailing Address - Fax:614-846-1704
Practice Address - Street 1:55 CAREN AVE STE 170
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2552
Practice Address - Country:US
Practice Address - Phone:614-846-1527
Practice Address - Fax:614-846-1704
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044181207R00000X
OH35.090252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2821674Medicaid
IN200152320Medicaid
OH2821674Medicaid
IN200152320Medicaid
IN200420530AMedicaid
OH7351811Medicare PIN