Provider Demographics
NPI:1326816018
Name:WEISS, DAVID STAHLER
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:STAHLER
Last Name:WEISS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18781 STATE ROUTE 772 UNIT B
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-9472
Mailing Address - Country:US
Mailing Address - Phone:740-708-0908
Mailing Address - Fax:
Practice Address - Street 1:18781 STATE ROUTE 772 UNIT B
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9472
Practice Address - Country:US
Practice Address - Phone:740-708-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRK649905172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver