Provider Demographics
NPI:1679177588
Name:WESIG, MARK JAMES SR
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:WESIG
Suffix:SR
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 1:2533 ABINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4018
Mailing Address - Country:US
Mailing Address - Phone:330-310-5136
Mailing Address - Fax:
Practice Address - Street 1:2533 ABINGTON RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4018
Practice Address - Country:US
Practice Address - Phone:330-310-5136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker