Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 60630991 | WA |
NPI | 1073825303 |
---|---|
Provider Name | Elliott Mark Weiss |
First Address | Philadelphia, PA 19146-1812 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 03/03/2016 |