Provider Demographics
NPI:1730119496
Name:WEIZER, GIL A (MD)
Entity Type:Individual
Prefix:
First Name:GIL
Middle Name:A
Last Name:WEIZER
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 1:480 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-1715
Mailing Address - Country:US
Mailing Address - Phone:914-223-1747
Mailing Address - Fax:
Practice Address - Street 1:480 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-1715
Practice Address - Country:US
Practice Address - Phone:914-223-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057082208800000X
OH35.098482208800000X
CT73253208800000X
NY313599-01208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH270577733066OtherCARESOURCE
OH747737OtherANTHEM
OH654814OtherWELLCARE
772712OtherBUCKEYE - MEDICAID
OH700266OtherBUCKEYE - MEDICARE
OH0059879OtherMEDICAID
OH7249227OtherAETNA
OHH073800OtherMEDICARE
KY132639OtherCOVENTRY CARES
OHP01125188OtherRAIDROAD MEDICARE
IN412840MMMedicare ID - Type Unspecified
KY1171332OtherPASSPORT KY MEDICAID