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1356398952

NPI Code Detail

MEDICARE: THEODORE I WEITZ MD

MEDICARE: THEODORE I WEITZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	25991	WV
2	207P00000X	Emergency Medicine Physician	2005030572	MO
3	207P00000X	Emergency Medicine Physician	MD2008-0651	NM
4	207P00000X	Emergency Medicine Physician	18315	WI
5	208000000X	Pediatrics Physician	212862	MA
6	208D00000X	General Practice Physician	18315	WI
7	207P00000X	Emergency Medicine Physician	LT-1161	NH

General Provider Information

NPI Number	:	1356398952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE I WEITZ MD

Provider Business Mailing Address
First Line	:	240 S MAIN ST
Second Line	:
City	:	WOLFEBORO
State	:	NH
Zip	:	03894-4411
Country	:	US
Telephone Number	:	603-569-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 HOSPITAL DR
Second Line	:
City	:	PETERSBURG
State	:	WV
Zip	:	26847-9566
Country	:	US
Telephone Number	:	304-257-1026
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	02/03/2021

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Directions to “ THEODORE I WEITZ MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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