Provider Demographics
NPI:1245444074
Name:WEIMER, MATHEW BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:BENJAMIN
Last Name:WEIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:304-781-5159
Mailing Address - Fax:304-523-8115
Practice Address - Street 1:220 JOHNS CREEK ROAD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1513
Practice Address - Country:US
Practice Address - Phone:304-743-1407
Practice Address - Fax:304-743-4516
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.091875207Q00000X
WV22530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012382Medicaid
OH2849092Medicaid
KY7100228730Medicaid
WVWV1930C604Medicare PIN
WVWV1930D629Medicare PIN
WV3810012382Medicaid
OH2849092Medicaid
OH2030546Medicare PIN
WVWV1930CMedicare PIN
WVWV1930BMedicare PIN