Provider Demographics
NPI:1891783254
Name:WEITMAN, DAVID M (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:WEITMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3900
Mailing Address - Country:US
Mailing Address - Phone:207-907-1617
Mailing Address - Fax:207-907-1627
Practice Address - Street 1:360 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3979
Practice Address - Country:US
Practice Address - Phone:207-907-1617
Practice Address - Fax:207-907-1627
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015055207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME043006OtherANTHEM BCBS
MM7834Medicare ID - Type Unspecified
G98505Medicare UPIN