Provider Demographics
NPI:1427021203
Name:WEISS, DENNIS S (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:S
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 1:2340 WARD ST
Mailing Address - Street 2:101
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1124
Mailing Address - Country:US
Mailing Address - Phone:510-848-5308
Mailing Address - Fax:
Practice Address - Street 1:2340 WARD ST
Practice Address - Street 2:101
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1124
Practice Address - Country:US
Practice Address - Phone:510-848-5308
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG177512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG17751OtherINSURANCE PROVIDER NUMBER
CAG17751OtherINSURANCE PROVIDER NUMBER
CAA40185Medicare UPIN