Provider Demographics
NPI:1134313851
Name:IRVING L WEISSMAN MD, PC
Entity Type:Organization
Organization Name:IRVING L WEISSMAN MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-787-5503
Mailing Address - Street 1:280 WASHINGTON ST
Mailing Address - Street 2:
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:
Practice Address - Street 1:280 WASHINGTON ST
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00232268OtherNEIGHBOR HEALTH PLAN
030368OtherTUFTS
15275OtherHARVARD PILGRIM
MA0198862Medicaid
0800059OtherUNITED HEALTH CARE
0096167OtherAETNA
96167OtherUS HEALTH CARE
MAM13032OtherBLUE CROSS/BLUE SHIELD
MO7162Medicare PIN
MA0198862Medicaid