Provider Demographics
NPI:1518921253
Name:WEISSMAN, SETH DAVID (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:DAVID
Last Name:WEISSMAN
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 1:401 BURGESS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3469
Mailing Address - Country:US
Mailing Address - Phone:650-325-9906
Mailing Address - Fax:650-325-1295
Practice Address - Street 1:401 BURGESS DR
Practice Address - Street 2:SUITE B
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3469
Practice Address - Country:US
Practice Address - Phone:650-325-9906
Practice Address - Fax:650-325-1295
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MMM00087MOtherNHIC
E78339Medicare UPIN
OOG710541Medicare ID - Type Unspecified