Provider Demographics
NPI:1235143165
Name:WEIDMAN, AMY R (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:WEIDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 W MARKET ST
Mailing Address - Street 2:STE. A
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7040
Mailing Address - Country:US
Mailing Address - Phone:330-836-2828
Mailing Address - Fax:330-836-0959
Practice Address - Street 1:1755 W MARKET ST
Practice Address - Street 2:STE. A
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7040
Practice Address - Country:US
Practice Address - Phone:330-836-2828
Practice Address - Fax:330-836-0959
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35057181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0908361Medicaid
OHF01391Medicare UPIN
OH0908361Medicaid