Healthcare Provider Details

I. General information

NPI: 1891711891
Provider Name (Legal Business Name): ROBERT J WEISS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MEMORIAL MEDICAL DR
GREENVILLE SC
29605-4407
US

IV. Provider business mailing address

29 MEMORIAL MEDICAL DR
GREENVILLE SC
29605-4407
US

V. Phone/Fax

Practice location:
  • Phone: 864-220-1200
  • Fax: 864-220-1888
Mailing address:
  • Phone: 864-312-3105
  • Fax: 864-220-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberDO87521
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: