Provider Demographics
NPI:1417070822
Name:WEISZ, IGOR (MD)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:WEISZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IGOR
Other - Middle Name:
Other - Last Name:WEISZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:250 BON AIR ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1702
Mailing Address - Country:US
Mailing Address - Phone:415-499-6835
Mailing Address - Fax:415-507-4113
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-499-6835
Practice Address - Fax:415-507-4113
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA535292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53529OtherCA LICENSE
CAA53529OtherCA LICENSE
CAG17308Medicare UPIN
CA00A535290Medicare ID - Type UnspecifiedM-CARE ID