Healthcare Provider Details

I. General information

NPI: 1811946080
Provider Name (Legal Business Name): MARK ALAN WEINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 TUSCARAWAS ST W STE. 520
CANTON OH
44708-4644
US

IV. Provider business mailing address

2600 TUSCARAWAS ST W STE. 520
CANTON OH
44708-4644
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-0702
  • Fax: 330-454-0748
Mailing address:
  • Phone: 330-454-0702
  • Fax: 330-454-0748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35. 068607
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: