Provider Demographics
NPI:1356308159
Name:WEISS, LAWRENCE MARTIN (MD)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:MARTIN
Last Name:WEISS
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 1:31 COLUMBIA
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1460
Mailing Address - Country:US
Mailing Address - Phone:949-643-7357
Mailing Address - Fax:949-425-5865
Practice Address - Street 1:31 COLUMBIA
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-1460
Practice Address - Country:US
Practice Address - Phone:949-643-7357
Practice Address - Fax:949-425-5865
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41422207ZP0101X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37595Medicare UPIN
CA00C414220Medicaid
CAWC41422AMedicare ID - Type Unspecified