Provider Demographics
NPI:1437148590
Name:WEISS, DANIEL (MD FACP CDE)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD FACP CDE
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 19160
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-0160
Mailing Address - Country:US
Mailing Address - Phone:440-833-4056
Mailing Address - Fax:440-833-4068
Practice Address - Street 1:8300 TYLER BOULEVARD
Practice Address - Street 2:SUITE 102
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4251
Practice Address - Country:US
Practice Address - Phone:440-266-5000
Practice Address - Fax:440-266-5004
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0626871Medicaid
OH0626871Medicaid
OHWE7330821Medicare ID - Type Unspecified