Provider Demographics
NPI:1083777403
Name:WEISS, ROBERT (M D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TOTAL ACCESS MEDICAL
Mailing Address - Street 2:191 PRESIDENTIAL BLVD C135
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004
Mailing Address - Country:US
Mailing Address - Phone:610-667-7203
Mailing Address - Fax:610-667-0447
Practice Address - Street 1:TOTAL ACCESS MEDICAL
Practice Address - Street 2:191 PRESIDENTIAL BLVD C135
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004
Practice Address - Country:US
Practice Address - Phone:610-667-7203
Practice Address - Fax:610-667-0447
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010265E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
30863Medicare UPIN