Provider Demographics
NPI:1720193113
Name:WEISSBERG, JOSEPH BURT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BURT
Last Name:WEISSBERG
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 1:760 SAYBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-704-0106
Mailing Address - Fax:860-704-0125
Practice Address - Street 1:536 SAYBROOK ROAD
Practice Address - Street 2:MIDDLESEX HOSPITAL CANCER CENTER
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-358-2100
Practice Address - Fax:860-358-2110
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021742085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001217454Medicaid
CT001217454Medicaid
E01279Medicare UPIN
300000825Medicare ID - Type Unspecified