1518958024 NPI number — DR. ROBERT B WEITZMAN MD

Table of content: DR. ROBERT B WEITZMAN MD (NPI 1518958024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518958024 NPI number — DR. ROBERT B WEITZMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEITZMAN
Provider First Name:
ROBERT
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1518958024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHAMPTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01061-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-582-2022
Provider Business Mailing Address Fax Number:
413-582-2530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 RUSSELL ST
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
HADLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01035-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-586-6020
Provider Business Practice Location Address Fax Number:
413-584-0286
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  60098 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3038408 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000007922 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1024120 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 20407 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J07545 . This is a "MEDICARE LEGACY NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 600981 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 71793 . This is a "HARVARD PILGRIM HEALTHPLA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7280191 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J07545 . This is a "BCBS OF MASSACHUSETTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 080116920 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 060098 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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