Provider Demographics
NPI:1174507164
Name:WEITZMAN, DOUGLAS K (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:K
Last Name:WEITZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20209 SENTARA WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-3574
Mailing Address - Country:US
Mailing Address - Phone:757-542-2000
Mailing Address - Fax:757-542-2001
Practice Address - Street 1:20209 SENTARA WAY STE 200
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-3574
Practice Address - Country:US
Practice Address - Phone:757-542-2000
Practice Address - Fax:757-542-2001
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA381159OtherANTHEM PROVIDER NUMBER
VA7300743Medicaid
VA41040OtherOPTIMA HEALTH PROVIDER NO
VA7300743Medicaid
VA381159OtherANTHEM PROVIDER NUMBER