Provider Demographics
NPI:1205989555
Name:WEISS, PAUL I (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:I
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:ONE WASHINGTON STRRET
Mailing Address - Street 2:COMMUNITY COUNSELING OF BRISTOL COUNTY
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780
Mailing Address - Country:US
Mailing Address - Phone:508-828-9116
Mailing Address - Fax:508-828-9146
Practice Address - Street 1:ONE WASHINGTON STRRET
Practice Address - Street 2:COMMUNITY COUNSELING OF BRISTOL COUNTY
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780
Practice Address - Country:US
Practice Address - Phone:508-828-9116
Practice Address - Fax:508-828-9146
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022360E2084P0800X
MA2036502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28579Medicare UPIN
PA58817Medicare ID - Type Unspecified