Provider Demographics
NPI:1265527477
Name:WEISENBERGER, GARY A (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:WEISENBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4600 WESLEY AVE
Mailing Address - Street 2:STE N
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2298
Mailing Address - Country:US
Mailing Address - Phone:513-246-7796
Mailing Address - Fax:513-246-7855
Practice Address - Street 1:2001 ANDERSON FERRY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3325
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-246-5627
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35050637208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0558169Medicaid
OH0558169Medicaid
OHWE4198921Medicare PIN