Healthcare Provider Details

I. General information

NPI: 1619617768
Provider Name (Legal Business Name): TATUM WEISHAUPT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
ALBANY NY
12208-3478
US

IV. Provider business mailing address

43 NEW SCOTLAND AVE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
ALBANY NY
12208-3478
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-4942
  • Fax:
Mailing address:
  • Phone: 518-264-5026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number64693
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: