MEDICARE: VASANTA P WEISS MD

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	207RN0300X	Nephrology Physician	0101235866	VA
2	207R00000X	Internal Medicine Physician	36915	AZ

General Provider Information

NPI Number	:	1417165671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VASANTA P WEISS MD

Provider Business Mailing Address
First Line	:	5055 E BROADWAY BLVD STE A100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3629
Country	:	US
Telephone Number	:	520-327-0460
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 W ORANGE GROVE RD STE 207
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1151
Country	:	US
Telephone Number	:	520-742-0999
Fax Number	:	520-742-6563

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

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	11/27/2023

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Directions to “ VASANTA P WEISS MD” Practice Location

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