Provider Demographics
NPI:1447369491
Name:WEBER, JAMES LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LAWRENCE
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N ELM ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6302
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:
Practice Address - Street 1:7500 STATE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2439
Practice Address - Country:US
Practice Address - Phone:513-231-8885
Practice Address - Fax:513-231-5607
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350452632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000014195OtherANTHEM
OH0641505Medicaid
OH300016963OtherRAILROAD MEDICARE
OH0641505Medicaid
OHD33246Medicare UPIN