Provider Demographics
NPI:1497721039
Name:WEISMAN, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:WEISMAN
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 4127
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-0127
Mailing Address - Country:US
Mailing Address - Phone:540-344-9779
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:42 LAMBERT ST
Practice Address - Street 2:SUITE 422
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2421
Practice Address - Country:US
Practice Address - Phone:540-513-3633
Practice Address - Fax:540-344-7154
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine