Healthcare Provider Details

I. General information

NPI: 1417121716
Provider Name (Legal Business Name): ANDREW CAMPBELL WEIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

PO BOX 8423
GREENVILLE NC
27835-8423
US

V. Phone/Fax

Practice location:
  • Phone: 303-548-9730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN8594
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2013-00837
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: