Provider Demographics
NPI:1528004942
Name:WEISERBS, DENNIS BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:BARRY
Last Name:WEISERBS
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 1:202 DUKE OF GLOUCHESTER STREET
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-345-4900
Mailing Address - Fax:540-345-4179
Practice Address - Street 1:202 DUKE OF GLOUCHESTER STREET
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-345-4900
Practice Address - Fax:540-345-4179
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031465207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5850690Medicaid
VA100000267Medicare ID - Type Unspecified
VA5850690Medicaid