MEDICARE: LISA N WEISS 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	207Q00000X	Family Medicine Physician	35.081243	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558359034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA N WEISS MD

Provider Business Mailing Address
First Line	:	8423 MARKET ST STE 101
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-6778
Country	:	US
Telephone Number	:	330-729-8700
Fax Number	:	330-729-8701

Provider Business Practice Location Address
First Line	:	8423 MARKET ST STE 101
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-6778
Country	:	US
Telephone Number	:	330-729-8700
Fax Number	:	330-729-8701

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	03/28/2018

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Directions to “ LISA N WEISS MD” Practice Location

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