Provider Demographics
NPI:1669470225
Name:WEISBERG, EDWARD SAUL (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:SAUL
Last Name:WEISBERG
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 1:2545 MOSSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3520
Mailing Address - Country:US
Mailing Address - Phone:412-373-8710
Mailing Address - Fax:412-373-8486
Practice Address - Street 1:2545 MOSSIDE BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3520
Practice Address - Country:US
Practice Address - Phone:412-373-8710
Practice Address - Fax:412-373-8486
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD007943E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B32745Medicare UPIN