Provider Demographics
NPI:1922077593
Name:WEISBERGER, ANITA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:LYNN
Last Name:WEISBERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 DIXIE HWY STE C
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2882
Mailing Address - Country:US
Mailing Address - Phone:859-292-9215
Mailing Address - Fax:859-292-9220
Practice Address - Street 1:1955 DIXIE HWY
Practice Address - Street 2:STE C
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-2792
Practice Address - Country:US
Practice Address - Phone:859-341-5550
Practice Address - Fax:859-344-3782
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082722207V00000X
KY38229207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64068141Medicaid
OH2417852Medicaid
OHP01933970OtherRAILROAD MEDICARE
KY64068141Medicaid
KY0677404Medicare PIN