Provider Demographics
NPI:1437298189
Name:WEBER, RICHARD BARRY (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BARRY
Last Name:WEBER
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 1:1275 SUMMER ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5315
Mailing Address - Country:US
Mailing Address - Phone:203-353-1857
Mailing Address - Fax:203-969-7191
Practice Address - Street 1:1275 SUMMER ST
Practice Address - Street 2:SUITE 103
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5315
Practice Address - Country:US
Practice Address - Phone:203-353-1857
Practice Address - Fax:203-969-7191
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027656207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010027656CT01OtherANTHEM BCBS
CTD77002Medicare UPIN