Provider Demographics
NPI:1821136169
Name:WEISBERG, MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
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 1:1645 NOBLE CIR
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1566
Mailing Address - Country:US
Mailing Address - Phone:215-350-1188
Mailing Address - Fax:215-635-1576
Practice Address - Street 1:1645 NOBLE CIR
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1566
Practice Address - Country:US
Practice Address - Phone:215-350-1188
Practice Address - Fax:215-635-1576
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2021-08-04
Deactivation Date:2011-03-31
Deactivation Code:
Reactivation Date:2011-10-06
Provider Licenses
StateLicense IDTaxonomies
PAMD014360E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC29296Medicare UPIN