Healthcare Provider Details

I. General information

NPI: 1013945708
Provider Name (Legal Business Name): AARON R WEISS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS DRIVE UNIT 107
SCARBOROUGH ME
04074-9692
US

IV. Provider business mailing address

301C US ROUTE ONE
SCARBOROUGH ME
04074-9701
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-7565
  • Fax: 207-885-7577
Mailing address:
  • Phone: 207-396-8600
  • Fax: 207-396-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number25MB08085000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number2317
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: