Healthcare Provider Details

I. General information

NPI: 1922443423
Provider Name (Legal Business Name): SCOTT R WEISSMAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 STATE HWY RTE 6
WELLFLEET MA
02667-7402
US

IV. Provider business mailing address

1 HOSPITAL ROAD
OAK BLUFFS MA
02557-1477
US

V. Phone/Fax

Practice location:
  • Phone: 508-349-3131
  • Fax: 508-487-6298
Mailing address:
  • Phone: 508-957-0111
  • Fax: 508-696-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN283179
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN83179
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: