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Individual

KENNETH WEISMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
400 MATTHEW ST, SUITE 303, MARIETTA, OH 45750-1644
(740) 373-7828
(740) 373-5898
Mailing address
201 N MOUNTAIN RD, PLAINVILLE, CT 06062-1848
(740) 374-4500
(740) 374-5887

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
35.097897
OH
208800000X
Urology Physician
47702
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000727239
ANTHEM
OH
01
000000728272
ANTHEM
OH
05
0052750
OH
05
3810021225
WV
01
P01216329
RAILROAD MEDICARE
OH
Enumeration date
03/27/2006
Last updated
08/14/2019
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