MEDICARE: DEAN C WEIL CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	0001084900	VA
2	367500000X	Certified Registered Nurse Anesthetist	0024084900	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043214620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAN C WEIL CRNA

Provider Business Mailing Address
First Line	:	1637 FAIRFIELD GREEN RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-4065
Country	:	US
Telephone Number	:	804-741-3125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 LEE ST
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22908-0001
Country	:	US
Telephone Number	:	434-982-4228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	09/16/2013

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