Provider Demographics
NPI:1700150794
Name:NOAH D. WEISS, MD INC
Entity Type:Organization
Organization Name:NOAH D. WEISS, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-935-5600
Mailing Address - Street 1:DEPT LA 24687
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-4687
Mailing Address - Country:US
Mailing Address - Phone:707-935-5600
Mailing Address - Fax:707-935-5606
Practice Address - Street 1:462 W NAPA ST STE A
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6519
Practice Address - Country:US
Practice Address - Phone:707-935-5600
Practice Address - Fax:707-935-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70397207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE89485Medicare UPIN
CA00G703970Medicare PIN