Healthcare Provider Details

I. General information

NPI: 1144315292
Provider Name (Legal Business Name): ROBERT ANTHONY WEAKLAND PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-5011
US

IV. Provider business mailing address

12611 LONGMEAD AVE
CLEVELAND OH
44135-3503
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7550
  • Fax: 216-844-1202
Mailing address:
  • Phone: 216-476-1542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50-00-0849
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: