Provider Demographics
NPI:1851372288
Name:WEIDMANN, CHARLES ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ERNEST
Last Name:WEIDMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15243 VANOWEN STREET
Mailing Address - Street 2:SUITE 306
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3649
Mailing Address - Country:US
Mailing Address - Phone:818-781-0232
Mailing Address - Fax:818-781-4132
Practice Address - Street 1:15243 VANOWEN ST
Practice Address - Street 2:SUITE 306
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3649
Practice Address - Country:US
Practice Address - Phone:818-781-0232
Practice Address - Fax:818-781-4132
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG048620174400000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G486200Medicaid
CA00G486200Medicaid
CAA51118Medicare UPIN