Healthcare Provider Details

I. General information

NPI: 1164405130
Provider Name (Legal Business Name): ROBERT M. WEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 POND MEADOW DRIVE SUITE 101
READING MA
01867
US

IV. Provider business mailing address

20 POND MEADOW DRIVE SUITE 101
READING MA
01867
US

V. Phone/Fax

Practice location:
  • Phone: 781-942-7000
  • Fax: 781-942-7200
Mailing address:
  • Phone: 781-942-7000
  • Fax: 781-942-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number59457
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number59457
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: