Provider Demographics
NPI:1588672570
Name:WEISSMAN, DEBRA SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUSAN
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:40 CROSS STREET
Mailing Address - Street 2:SUITE 340
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-847-1500
Mailing Address - Fax:203-845-8764
Practice Address - Street 1:40 CROSS STREET
Practice Address - Street 2:DERMATOLOGY CENTER PC SUITE 340
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-847-1500
Practice Address - Fax:203-845-8764
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT029505207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
010029505CT01OtherANTHEM BLUE SHIELD
SZ1003OtherOXFORD HEALTH PLAN
CONNM79222OtherPRIVATE HEALTHCARE
0567956OtherAETNA
295050OtherCONNECTICARE
SZ1003OtherOXFORD HEALTH PLAN