Provider Demographics
NPI:1942339544
Name:ROBERT A. WEISSMAN, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT A. WEISSMAN, M.D. A MEDICAL CORPORATION
Other - Org Name:ROBERT A. WEISSMAN, M.D. A MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-986-1357
Mailing Address - Street 1:5620 WILBUR AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1309
Mailing Address - Country:US
Mailing Address - Phone:818-986-1357
Mailing Address - Fax:818-986-3282
Practice Address - Street 1:5620 WILBUR AVE STE 214
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1309
Practice Address - Country:US
Practice Address - Phone:818-388-1933
Practice Address - Fax:818-986-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG9913174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9913Medicare ID - Type UnspecifiedA MEDICAL CORPORATION