Provider Demographics
NPI:1770596314
Name:WEISS, MARTIN J (MD)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:J
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 771350
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38177-1350
Mailing Address - Country:US
Mailing Address - Phone:901-684-5356
Mailing Address - Fax:901-761-5542
Practice Address - Street 1:6401 POPLAR AVE
Practice Address - Street 2:STE 270
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4846
Practice Address - Country:US
Practice Address - Phone:901-763-1695
Practice Address - Fax:901-682-3150
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000031995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3879214Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TNH76693Medicare UPIN