Provider Demographics
NPI:1255549101
Name:WEISS, SEAN RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:RICHARD
Last Name:WEISS
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 1:2201 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6323
Mailing Address - Country:US
Mailing Address - Phone:504-814-3223
Mailing Address - Fax:504-265-9498
Practice Address - Street 1:2201 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 408
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6323
Practice Address - Country:US
Practice Address - Phone:504-814-3223
Practice Address - Fax:504-265-9498
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201036207YS0123X, 207Y00000X
LAMD2010362082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1238333Medicaid
LA1238333Medicaid