MEDICARE: DR. MARSHALL A WEISSBERGER MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	0101037062	VA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	300084249	OTHER	VA	RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	139178	OTHER	VA	BCBS
2	15810	OTHER	VA	OPTIMA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	15810	OTHER	VA	SENTARA

NPI Number	:	1174507354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARSHALL A WEISSBERGER MD

Provider Business Mailing Address
First Line	:	5544 GREENWICH RD STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6563
Country	:	US
Telephone Number	:	757-466-0089
Fax Number	:	757-466-8017

Provider Business Practice Location Address
First Line	:	5544 GREENWICH RD STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6563
Country	:	US
Telephone Number	:	757-466-0089
Fax Number	:	757-466-8017

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	02/07/2014

5544 GREENWICH RD STE 302
VIRGINIA BEACH, VA
23462-6563

Practice Phone: 757-461-0600
Practice Fax: 757-461-0610

5544 GREENWICH RD STE 200
VIRGINIA BEACH, VA
23462-6563