Provider Demographics
NPI:1841253028
Name:WEISS, ROGER M (DO)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:M
Last Name:WEISS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:701 WHITE POND DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1127
Mailing Address - Country:US
Mailing Address - Phone:330-572-1011
Mailing Address - Fax:330-572-1018
Practice Address - Street 1:6847 N CHESTNUT ST
Practice Address - Street 2:SUITE 330
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3929
Practice Address - Country:US
Practice Address - Phone:330-296-8048
Practice Address - Fax:330-296-8208
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34006137W2084N0400X
CO0546292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000328351OtherANTHEM BLUECROSS/BLUESHEI
OHP00140783OtherRAILROAD MEDICARE
CO025996OtherKAISER COMMERCIAL NUMBER
CO91606713Medicaid
OH0164610Medicaid
OH341097565RWOtherSUMMACARE
OH729708OtherBUCKEYE COMMUNITY HEALTH
OHWE4019863Medicare PIN
OHC26472Medicare UPIN
CO025996OtherKAISER COMMERCIAL NUMBER