Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD11285 | DC |
NPI | 1013092386 |
---|---|
Provider Name | Mark I Weissman |
First Address | Washington, DC 20010-2978 |
Second Address | Washington, DC 20010-2978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 11/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011136900 | (05) | DC |
455601100 | (05) | MD |
6735703 | (05) | VA |
D09297 | (02) |