Healthcare Provider Details

I. General information

NPI: 1841253028
Provider Name (Legal Business Name): ROGER M WEISS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6847 N CHESTNUT ST SUITE 330
RAVENNA OH
44266-3929
US

IV. Provider business mailing address

701 WHITE POND DR SUITE 300
AKRON OH
44320-1127
US

V. Phone/Fax

Practice location:
  • Phone: 330-296-8048
  • Fax: 330-296-8208
Mailing address:
  • Phone: 330-572-1011
  • Fax: 330-572-1018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number34006137W
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number054629
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: