Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | D0024827 | MD |
NPI | 1265497192 |
---|---|
Provider Name | Dr. Robert Edward Weiss |
First Address | Hagerstown, MD 21740 |
Second Address | Hagerstown, MD 21740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 14/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D78198 | (02) | MD |