Provider Demographics
NPI:1518144690
Name:STUART WEISBERG, MD, LLC
Entity Type:Organization
Organization Name:STUART WEISBERG, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ATTENDING
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:G
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:971-230-0822
Mailing Address - Street 1:1971 NW OVERTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1618
Mailing Address - Country:US
Mailing Address - Phone:971-230-0822
Mailing Address - Fax:971-230-0823
Practice Address - Street 1:1971 NW OVERTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1618
Practice Address - Country:US
Practice Address - Phone:971-230-0822
Practice Address - Fax:971-230-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD234022084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R118070Medicare PIN