Provider Demographics
NPI:1376634378
Name:WEISS, EDWARD ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ARTHUR
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 WELCH ROAD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1803
Mailing Address - Country:US
Mailing Address - Phone:650-326-6560
Mailing Address - Fax:650-321-2324
Practice Address - Street 1:900 WELCH ROAD
Practice Address - Street 2:SUITE 208
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1803
Practice Address - Country:US
Practice Address - Phone:650-326-6560
Practice Address - Fax:650-321-2324
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26171208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G261710Medicare ID - Type Unspecified
A42926Medicare UPIN