Provider Demographics
NPI:1528008497
Name:WEISS, MICHAEL ARMAND (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ARMAND
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 1:4676 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17329-9275
Mailing Address - Country:US
Mailing Address - Phone:717-744-5091
Mailing Address - Fax:717-744-5091
Practice Address - Street 1:4676 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:PA
Practice Address - Zip Code:17329-9275
Practice Address - Country:US
Practice Address - Phone:717-744-5091
Practice Address - Fax:717-744-5091
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055277L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ379174Medicaid
AZZ81186Medicare PIN
AZ379174Medicaid
PA126060Medicare PIN