Provider Demographics
NPI:1801822648
Name:WEITZEL, RICHARD LEONARD JR (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEONARD
Last Name:WEITZEL
Suffix:JR
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 1:405 NILES CORTLAND RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2460
Mailing Address - Country:US
Mailing Address - Phone:330-372-2121
Mailing Address - Fax:330-372-2120
Practice Address - Street 1:405 NILES CORTLAND RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2460
Practice Address - Country:US
Practice Address - Phone:330-372-2121
Practice Address - Fax:330-372-2120
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053990W207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA68307Medicare UPIN