Provider Demographics
NPI:1588647622
Name:WEISS, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
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 1:54 SCOTT ADAM ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3360
Mailing Address - Country:US
Mailing Address - Phone:410-666-3960
Mailing Address - Fax:410-666-3981
Practice Address - Street 1:54 SCOTT ADAM ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-3360
Practice Address - Country:US
Practice Address - Phone:410-666-3960
Practice Address - Fax:410-666-3981
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027192174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD087SMedicare ID - Type Unspecified
MDD74548Medicare UPIN
MDKK42Medicare PIN