Provider Demographics
NPI:1902858764
Name:WEISS, MARTIN BRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:BRAM
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:SUITE 560
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-964-5599
Mailing Address - Fax:617-964-5577
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 560
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-964-5599
Practice Address - Fax:617-964-5577
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA53615208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B74526Medicare UPIN
J03765Medicare ID - Type Unspecified