Individual
PAUL DANIEL WEIDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
420 DURANT ST, SOUTH HILL, VA 23970-1614
(434) 584-0046
(434) 584-0083
Mailing address
PO BOX 623, SOUTH HILL, VA 23970-0623
(434) 584-0046
(434) 584-0083
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101261879
VA
207Q00000X
Family Medicine Physician
21733
WV
207Q00000X
Family Medicine Physician
3584922
OH
207QA0401X
Addiction Medicine (Family Medicine) Physician
0101261879
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001712686
MS BLUE CROSS BLUE SHIELD
WV
05
—
2513917
—
OH
05
—
3810001239
—
WV
01
—
P00220382
RAILROAD MEDICARE
—
Enumeration date
08/31/2006
Last updated
03/17/2018
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