Healthcare Provider Details

I. General information

NPI: 1851552467
Provider Name (Legal Business Name): CONSTANCE GESINA WEISMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST DEPARTMENT OF PEDIATRICS, YALE SCHOOL OF MEDICINE
NEW HAVEN CT
06510-8064
US

IV. Provider business mailing address

333 CEDAR ST DEPARTMENT OF PEDIATRICS, YALE SCHOOL OF MEDICINE
NEW HAVEN CT
06510-8064
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2022
  • Fax:
Mailing address:
  • Phone: 203-785-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number048822
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberAFE99691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: