Healthcare Provider Details

I. General information

NPI: 1427021203
Provider Name (Legal Business Name): DENNIS S WEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 WARD ST 101
BERKELEY CA
94705-1124
US

IV. Provider business mailing address

2340 WARD ST 101
BERKELEY CA
94705-1124
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-5308
  • Fax:
Mailing address:
  • Phone: 510-848-5308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG17751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: