1669729851 NPI number — WEISS PEDIATRICS PLLC

Table of content: (NPI 1669729851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669729851 NPI number — WEISS PEDIATRICS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEISS PEDIATRICS PLLC
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:
1669729851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11123
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-402-1000
Provider Business Mailing Address Fax Number:
617-402-1099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2082 MESQUITE AVE
Provider Second Line Business Practice Location Address:
SUITE A-102
Provider Business Practice Location Address City Name:
LAKE HAVASU CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86403-6710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-680-1264
Provider Business Practice Location Address Fax Number:
982-680-1265
Provider Enumeration Date:
08/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WEISS
Authorized Official First Name:
PRABHA
Authorized Official Middle Name:
SWAMY
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
928-680-1264

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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