Provider Demographics
NPI:1609886878
Name:WEISS, DAVID TODD (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TODD
Last Name:WEISS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 E PARHAM RD STE 215
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4373
Mailing Address - Country:US
Mailing Address - Phone:804-346-1779
Mailing Address - Fax:804-545-9040
Practice Address - Street 1:7650 E PARHAM RD STE 215
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-346-1779
Practice Address - Fax:804-545-9040
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001050213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA410038864OtherMEDICARE, RAILROAD
VA009303472Medicaid
VAU66377Medicare UPIN
VA009303472Medicaid