Provider Demographics
NPI:1750391058
Name:JAMES A. WEIDMAN, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:JAMES A. WEIDMAN, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:WEIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD FAA P
Authorized Official - Phone:818-713-1977
Mailing Address - Street 1:7320 WOODLAKE AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1470
Mailing Address - Country:US
Mailing Address - Phone:818-713-9377
Mailing Address - Fax:818-713-1924
Practice Address - Street 1:7320 WOODLAKE AVE STE 270
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1470
Practice Address - Country:US
Practice Address - Phone:818-713-9377
Practice Address - Fax:818-713-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG4607602080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G460760Medicaid