Basic Information
| Provider Information | |||||||||
| NPI: | 1831483635 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARL B WEISS MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5711 CHAMBERLAYNE RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232272415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042626900 | ||||||||
| FaxNumber: | 8042663530 | ||||||||
| Practice Location | |||||||||
| Address1: | 8220 MEADOWBRIDGE RD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231162336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015687240 | ||||||||
| FaxNumber: | 8042663530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2011 | ||||||||
| LastUpdateDate: | 08/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8047898600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0101242939 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | VV20929952 | 01 | VA | MEDICARE PTAN | OTHER |