Provider Demographics
NPI:1558802355
Name:WEIRICH, BETHANY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:WEIRICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:M
Other - Last Name:MALLORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2109 HUGHES DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3856
Mailing Address - Country:US
Mailing Address - Phone:419-291-5150
Mailing Address - Fax:419-479-6173
Practice Address - Street 1:1 SEAGATE
Practice Address - Street 2:#800
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1558
Practice Address - Country:US
Practice Address - Phone:567-585-1983
Practice Address - Fax:419-824-7359
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005051RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant