Provider Demographics
NPI:1861481640
Name:WEISS, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:A
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7071 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-2700
Mailing Address - Country:US
Mailing Address - Phone:419-843-1370
Mailing Address - Fax:419-843-1362
Practice Address - Street 1:3400 MEIJER DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1166
Practice Address - Country:US
Practice Address - Phone:419-843-1370
Practice Address - Fax:419-843-1362
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081791207LP2900X
OH35.081791208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2357480Medicaid
OH000000572587OtherANTHEM
MIMI4975002Medicare PIN
OH000000572587OtherANTHEM