Provider Demographics
NPI:1922352632
Name:WEIDMAN, JAMES ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ADAM
Last Name:WEIDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:ADAM
Other - Last Name:WEIDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7325 MEDICAL CENTER DR
Mailing Address - Street 2:#205
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1925
Mailing Address - Country:US
Mailing Address - Phone:818-713-9377
Mailing Address - Fax:818-713-1924
Practice Address - Street 1:7325 MEDICAL CENTER DR
Practice Address - Street 2:#205
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1925
Practice Address - Country:US
Practice Address - Phone:818-713-9377
Practice Address - Fax:818-713-1924
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46076208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G460760Medicaid