Healthcare Provider Details

I. General information

NPI: 1538150503
Provider Name (Legal Business Name): ROBERT DANIEL WEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WAYMAN LN
BAR HARBOR ME
04609-1625
US

IV. Provider business mailing address

PO BOX 8 10 WAYMAN LANE
BAR HARBOR ME
04609-0008
US

V. Phone/Fax

Practice location:
  • Phone: 207-288-5081
  • Fax: 207-288-8449
Mailing address:
  • Phone: 207-288-5081
  • Fax: 207-288-8449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number013771
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number013771
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number013771
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: