Provider Demographics
NPI:1700872157
Name:WEISER, HARRY C (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:C
Last Name:WEISER
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 1:345 OSPREY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9400
Mailing Address - Country:US
Mailing Address - Phone:334-698-1052
Mailing Address - Fax:
Practice Address - Street 1:700 1ST AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1802
Practice Address - Country:US
Practice Address - Phone:701-234-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20126207T00000X
ND14795207T00000X
GA039979207T00000X
ALMD31203207T00000X
FLME 117364207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000649888DMedicaid
GAP00358730OtherRR MEDICARE
FLHQ700ZMedicare PIN
GA000649888DMedicaid
GAP00358730OtherRR MEDICARE
AL102I148475Medicare PIN