Provider Demographics
NPI:1700925591
Name:WEISS, MICHAEL F (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
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 1:382 BETWEEN THE LAKES ROAD
Mailing Address - Street 2:P.O.BOX 48
Mailing Address - City:TACONIC
Mailing Address - State:CT
Mailing Address - Zip Code:06079
Mailing Address - Country:US
Mailing Address - Phone:413-528-4014
Mailing Address - Fax:
Practice Address - Street 1:VOLUNTEERS IN MEDICINE BERKSHIRES
Practice Address - Street 2:777 MAIN STREET SUITE 4
Practice Address - City:GT. BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230
Practice Address - Country:US
Practice Address - Phone:413-528-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227229208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics