Healthcare Provider Details

I. General information

NPI: 1376817023
Provider Name (Legal Business Name): VERNE WEISBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 FORE RIVER PKWY SUITE 140
PORTLAND ME
04102-2780
US

IV. Provider business mailing address

195 FORE RIVER PKWY SUITE 140
PORTLAND ME
04102-2780
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-1933
  • Fax: 207-871-9316
Mailing address:
  • Phone: 207-775-1933
  • Fax: 207-871-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number012424
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: