Provider Demographics
NPI:1376776781
Name:WEITZMAN, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
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 1:4701 S OCEAN BLVD APT 5F
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-5367
Mailing Address - Country:US
Mailing Address - Phone:843-222-5395
Mailing Address - Fax:866-340-0296
Practice Address - Street 1:1016 2ND AVE N STE 203
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3288
Practice Address - Country:US
Practice Address - Phone:843-222-5395
Practice Address - Fax:866-340-0296
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53530207P00000X, 207Q00000X, 207QA0401X
GA71752207P00000X, 2086S0129X, 207Q00000X, 207QA0401X
IN01071702-A207P00000X
SC39135207P00000X, 207Q00000X, 2086S0129X, 207QA0401X
IN01071702207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA071752OtherGA MED LIC
IN01071702AOtherIN MED LICENSE
SC39135OtherSC LICENSE
WI53530-20OtherSTATE OF WISCONSIN
WI53530-20OtherSTATE OF WISCONSIN