Provider Demographics
NPI:1720285679
Name:WEISMAN, MARYANN THERESA (MD, MS, BA)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:THERESA
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:MD, MS, BA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:809 JEFFERSON STREET
Mailing Address - Street 2:POST OFFICE BOX 783
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-5525
Mailing Address - Country:US
Mailing Address - Phone:610-585-8157
Mailing Address - Fax:610-266-8040
Practice Address - Street 1:809 JEFFERSON STREET
Practice Address - Street 2:POST OFFICE BOX 783
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-5525
Practice Address - Country:US
Practice Address - Phone:610-585-8157
Practice Address - Fax:610-266-8040
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043771E2084P0800X, 2084P0802X, 2084P0804X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD043771EOtherSTATE LICENSE
BW5814567OtherFEDERAL DEA NUMBER