Provider Demographics
NPI:1497827430
Name:WEISS, ANDREW BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BENJAMIN
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 1:150 N ROBERTSON BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2145
Mailing Address - Country:US
Mailing Address - Phone:310-652-1800
Mailing Address - Fax:310-652-1804
Practice Address - Street 1:150 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2145
Practice Address - Country:US
Practice Address - Phone:310-652-1800
Practice Address - Fax:310-652-1804
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73086207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA73086DMedicare PIN
CA6394480001Medicare NSC
CAH83027Medicare UPIN