Provider Demographics
NPI:1427189059
Name:JOEL M. WEISSMAN M.D.P.C.
Entity Type:Organization
Organization Name:JOEL M. WEISSMAN M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-745-4130
Mailing Address - Street 1:7500 CENTRAL AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2430
Mailing Address - Country:US
Mailing Address - Phone:215-745-4130
Mailing Address - Fax:215-745-9666
Practice Address - Street 1:7500 CENTRAL AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19111-2430
Practice Address - Country:US
Practice Address - Phone:215-745-4130
Practice Address - Fax:215-745-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014154E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0674929Medicaid
PA058844Medicare ID - Type Unspecified
PA0674929Medicaid