Provider Demographics
NPI:1922017763
Name:WEISSMAN, JOEL MARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MARVIN
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7604 CENTRAL AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2433
Mailing Address - Country:US
Mailing Address - Phone:215-745-4130
Mailing Address - Fax:215-745-9666
Practice Address - Street 1:7604 CENTRAL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2433
Practice Address - Country:US
Practice Address - Phone:215-745-4130
Practice Address - Fax:215-745-9666
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA014154E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0674929Medicaid
PA0674929Medicaid
PAC28583Medicare UPIN