Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 35056985 | OH |
NPI | 1013047695 |
---|---|
Provider Name | Dr. Charles Arthur Weber |
First Address | North Ridgeville, OH 44039-5311 |
Second Address | North Ridgeville, OH 44039-5311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 28/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0837812 | (05) | OH |
F05896 | (02) | OH |
WE0711171 | PIN# (01) | OH |