Healthcare Provider Details

I. General information

NPI: 1306131164
Provider Name (Legal Business Name): ALISON WEISS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON SHINGLER D.O.

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR
SPRINGFIELD OH
45504-2687
US

IV. Provider business mailing address

10621 CHURCHILL DR
POWELL OH
43065-8629
US

V. Phone/Fax

Practice location:
  • Phone: 937-523-1402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.011113
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34-011113
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: