Provider Demographics
NPI:1558336867
Name:WEISMAN, TODD A (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:WEISMAN
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 1:200 EATON ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-4000
Mailing Address - Country:US
Mailing Address - Phone:757-726-5000
Mailing Address - Fax:757-726-5001
Practice Address - Street 1:200 EATON ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4000
Practice Address - Country:US
Practice Address - Phone:757-726-5000
Practice Address - Fax:757-510-9022
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005631572Medicaid
VA0080006521Medicare NSC
E24273Medicare UPIN