Healthcare Provider Details

I. General information

NPI: 1518958024
Provider Name (Legal Business Name): ROBERT B WEITZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 RUSSELL ST SUITE 7
HADLEY MA
01035-3534
US

IV. Provider business mailing address

PO BOX 5001
NORTHAMPTON MA
01061-5001
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-6020
  • Fax: 413-584-0286
Mailing address:
  • Phone: 413-582-2022
  • Fax: 413-582-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60098
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: