Provider Demographics
NPI:1013047695
Name:WEBER, CHARLES ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ARTHUR
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:34100 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-5311
Mailing Address - Country:US
Mailing Address - Phone:440-327-1000
Mailing Address - Fax:440-793-9950
Practice Address - Street 1:34100 CENTER RIDGE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-5311
Practice Address - Country:US
Practice Address - Phone:440-327-1000
Practice Address - Fax:440-793-9950
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350569852080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0837812Medicaid
OHWE0711171OtherPIN#
OH0837812Medicaid