Basic Information
| Provider Information | |||||||||
| NPI: | 1841253028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEISS | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 WHITE POND DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443201127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305721011 | ||||||||
| FaxNumber: | 3305721018 | ||||||||
| Practice Location | |||||||||
| Address1: | 6847 N CHESTNUT ST | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | RAVENNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442663929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302968048 | ||||||||
| FaxNumber: | 3302968208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 11/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 34006137W | OH | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 054629 | CO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 000000328351 | 01 | OH | ANTHEM BLUECROSS/BLUESHEI | OTHER | P00140783 | 01 | OH | RAILROAD MEDICARE | OTHER | 025996 | 01 | CO | KAISER COMMERCIAL NUMBER | OTHER | 91606713 | 05 | CO | MEDICAID | 0164610 | 05 | OH | MEDICAID | 341097565RW | 01 | OH | SUMMACARE | OTHER | 729708 | 01 | OH | BUCKEYE COMMUNITY HEALTH | OTHER |