Provider Demographics
NPI:1770682593
Name:WEISS, PETER DAVID (MD FAOG)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:DAVID
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD FAOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3469 N VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208
Mailing Address - Country:US
Mailing Address - Phone:818-249-6636
Mailing Address - Fax:818-249-5074
Practice Address - Street 1:421 NORTH RODEO DRIVE
Practice Address - Street 2:PENTHOUSE #1
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-275-5595
Practice Address - Fax:310-432-6647
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48941207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92860Medicare UPIN