Provider Demographics
NPI:1669729851
Name:WEISS PEDIATRICS PLLC
Entity type:Organization
Organization Name:WEISS PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRABHA
Authorized Official - Middle Name:SWAMY
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-680-1264
Mailing Address - Street 1:PO BOX 11123
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4002
Mailing Address - Country:US
Mailing Address - Phone:617-402-1000
Mailing Address - Fax:617-402-1099
Practice Address - Street 1:2082 MESQUITE AVE
Practice Address - Street 2:SUITE A-102
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6710
Practice Address - Country:US
Practice Address - Phone:928-680-1264
Practice Address - Fax:982-680-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty