Healthcare Provider Details

I. General information

NPI: 1801352539
Provider Name (Legal Business Name): AEJA WEISS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 05/28/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10TH MDG 4102 PINION DR
USAF ACADEMY CO
80840
US

IV. Provider business mailing address

10TH MDG 4102 PINION DR
USAF ACADEMY CO
80840
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101270792
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101270792
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: