Provider Demographics
NPI:1528018082
Name:WEISER, EDWARD BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:BRUCE
Last Name:WEISER
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 1:1938 PEACHTREE RD NW
Mailing Address - Street 2:SUITE #610
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1267
Mailing Address - Country:US
Mailing Address - Phone:404-605-2100
Mailing Address - Fax:404-609-6854
Practice Address - Street 1:1938 PEACHTREE RD NW
Practice Address - Street 2:SUITE #610
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1267
Practice Address - Country:US
Practice Address - Phone:404-605-2100
Practice Address - Fax:404-609-6854
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA33483207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE16889Medicare UPIN
GA98BBBBXMedicare ID - Type Unspecified