Healthcare Provider Details

I. General information

NPI: 1376776781
Provider Name (Legal Business Name): DAVID MARK WEITZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 2ND AVE N STE 203
NORTH MYRTLE BEACH SC
29582-3288
US

IV. Provider business mailing address

4701 S OCEAN BLVD APT 5F
NORTH MYRTLE BEACH SC
29582-5367
US

V. Phone/Fax

Practice location:
  • Phone: 843-222-5395
  • Fax: 866-340-0296
Mailing address:
  • Phone: 843-222-5395
  • Fax: 866-340-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53530
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number71752
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01071702-A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number53530
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number39135
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number71752
License Number StateGA
# 7
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39135
License Number StateSC
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39135
License Number StateSC
# 9
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number71752
License Number StateGA
# 10
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number71752
License Number StateGA
# 11
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number39135
License Number StateSC
# 12
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number53530
License Number StateWI
# 13
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01071702
License Number StateIN
# 14
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number39135
License Number StateSC
# 15
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number01071702
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: