Healthcare Provider Details

I. General information

NPI: 1700925591
Provider Name (Legal Business Name): MICHAEL F WEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VOLUNTEERS IN MEDICINE BERKSHIRES 777 MAIN STREET SUITE 4
GT. BARRINGTON MA
01230
US

IV. Provider business mailing address

382 BETWEEN THE LAKES ROAD P.O.BOX 48
TACONIC CT
06079
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-4014
  • Fax:
Mailing address:
  • Phone: 413-528-4014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number227229
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: