1063585800 NPI number — EDWARD A WEISS MD INC

Table of content: (NPI 1063585800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063585800 NPI number — EDWARD A WEISS MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD A WEISS MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063585800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 MIDDLEFIELD RD STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94301-2918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-326-6560
Provider Business Mailing Address Fax Number:
650-321-2324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 MIDDLEFIELD RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94301-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-326-6560
Provider Business Practice Location Address Fax Number:
650-321-2324
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEISS
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
650-326-6560

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  G26171 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)