Provider Demographics
NPI:1922023787
Name:WEISMAN, STUART W (MD)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:W
Last Name:WEISMAN
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 1:25 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2751
Mailing Address - Country:US
Mailing Address - Phone:508-421-2010
Mailing Address - Fax:508-756-8078
Practice Address - Street 1:25 OAK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2751
Practice Address - Country:US
Practice Address - Phone:508-421-2010
Practice Address - Fax:508-756-8078
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57799207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3019144Medicaid
J06289OtherBLUE SHIELD
B98016Medicare UPIN
J06289OtherBLUE SHIELD