Provider Demographics
NPI:1659324267
Name:WEISMAN, JOSEPH S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
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 1:1225 MAPLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4707
Mailing Address - Country:US
Mailing Address - Phone:540-345-2020
Mailing Address - Fax:540-344-0079
Practice Address - Street 1:1225 MAPLE AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4707
Practice Address - Country:US
Practice Address - Phone:540-345-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048960207W00000X, 207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
298425OtherBC/BS PROVIDER ID
VA006300944Medicaid
00X723W01OtherMEDICARE PTAN
C10500OtherGROUP PTAN
180019283Medicare ID - Type UnspecifiedRR MEDICARE PROVIDER ID
298425OtherBC/BS PROVIDER ID
C04340Medicare UPIN
C10500OtherGROUP PTAN