Provider Demographics
NPI:1770022089
Name:AMY R WEIDMAN MD LLC
Entity Type:Organization
Organization Name:AMY R WEIDMAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-836-2828
Mailing Address - Street 1:3610 W MARKET ST
Mailing Address - Street 2:STE 108
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9301
Mailing Address - Country:US
Mailing Address - Phone:330-836-2828
Mailing Address - Fax:330-836-0959
Practice Address - Street 1:3610 W MARKET ST
Practice Address - Street 2:STE 108
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9301
Practice Address - Country:US
Practice Address - Phone:330-836-2828
Practice Address - Fax:330-836-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty