Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 59457 | MA |
Y | 207VE0102X | Reproductive Endocrinologist | 59457 | MA |
NPI | 1164405130 |
---|---|
Provider Name | Robert Weiss |
First Address | Boston, MA 02118 |
Second Address | Boston, MA 02118-4001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 04/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110045805A | (05) | MA |
D93487 | (02) | MA |