Provider Demographics
NPI:1104862556
Name:WEISS, MARTIN H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:H
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5720
Mailing Address - Fax:323-442-7543
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:STE 3800
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5720
Practice Address - Fax:323-442-7543
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG24126207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD126ZOtherPTAN
CA00G241260Medicaid
CAA42171Medicare UPIN
CA00G241260Medicaid