Provider Demographics
NPI:1003866351
Name:WEISSMAN, IRVING LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:LOUIS
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:280 WASHINGTON ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3511
Mailing Address - Country:US
Mailing Address - Phone:617-787-5503
Mailing Address - Fax:617-787-1140
Practice Address - Street 1:280 WASHINGTON ST
Practice Address - Street 2:SUITE 308
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3511
Practice Address - Country:US
Practice Address - Phone:617-787-5503
Practice Address - Fax:617-787-1140
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30368207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0023268OtherNHP
0096167OtherAETNA
MA0198862Medicaid
15275OtherHARVARD PILGRAM NUMBER
030368OtherTUFTS HEALTH PLAN
MA30368OtherMEDICAL LICENSE NUMBER
08-00059OtherUNITED HEALTH CARE
4832OtherTARGET
8194OtherDAVIS
96167OtherU.S. HEALTH CARE
M07162Medicare ID - Type Unspecified
MA0198862Medicaid