Provider Demographics
NPI:1881699973
Name:WEIDMAN, CLARE D (MD)
Entity type:Individual
Prefix:
First Name:CLARE
Middle Name:D
Last Name:WEIDMAN
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 457
Mailing Address - Street 2:5 E ALVON ROAD, SUITE 7
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2373
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5051
Practice Address - Street 1:JACKSON RIVER ORTHOPEDICS
Practice Address - Street 2:1 ARH LANE, STE 102
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457
Practice Address - Country:US
Practice Address - Phone:540-862-6777
Practice Address - Fax:540-863-9167
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031888207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA258083OtherANTHEM
541839718OtherC&O
58613OtherCARELINK
4581381OtherAETNA
WV54183971800OtherWV WORKERS COMPENSATION
WV541839718048OtherBS MOUNTAIN STATE
VA006404979Medicaid
5191259OtherCCN
58613OtherSOUTHERN HEALTH
WV0099154000Medicaid
200026OtherLUNG
WV282196OtherANTHEM
VA541839718015OtherBS MOUNTAIN STATE
541839718OtherC&O
1200890004Medicare ID - Type UnspecifiedADMINSTAR FEDERAL
VA258083OtherANTHEM
4581381OtherAETNA
200026OtherLUNG
WV282196OtherANTHEM