MEDICARE: TYLER MARC WEISBERGER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	DO3215	ME
2	207R00000X	Internal Medicine Physician	DO01125	RI

General Provider Information

NPI Number	:	1093219818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER MARC WEISBERGER DO

Provider Business Mailing Address
First Line	:	455 TOLL GATE RD
Second Line	:	PRC AND CREDENTIALING
City	:	WARWICK
State	:	RI
Zip	:	02886-2759
Country	:	US
Telephone Number	:	401-273-0641
Fax Number	:	401-273-2919

Provider Business Practice Location Address
First Line	:	455 TOLL GATE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-2770
Country	:	US
Telephone Number	:	401-737-7010
Fax Number	:	401-767-1975

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	11/10/2025

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