Provider Demographics
NPI:1598710725
Name:JOHN VONWEISS M.D. INC
Entity Type:Organization
Organization Name:JOHN VONWEISS M.D. INC
Other - Org Name:VONWEISS DERMATOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:HANS
Authorized Official - Middle Name:ERICK
Authorized Official - Last Name:VON WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-744-2782
Mailing Address - Street 1:107 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2721
Mailing Address - Country:US
Mailing Address - Phone:978-744-2787
Mailing Address - Fax:978-744-7012
Practice Address - Street 1:107 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2721
Practice Address - Country:US
Practice Address - Phone:978-744-2782
Practice Address - Fax:978-744-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA744667207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3196615Medicaid
MAM10884OtherMEDICARE GROUP
MAM10884OtherMEDICARE GROUP