Healthcare Provider Details

I. General information

NPI: 1497701817
Provider Name (Legal Business Name): BARRY LEE WEISSGLASS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 GOER DR
NORTH CHARLESTON SC
29406-6500
US

IV. Provider business mailing address

4600 GOER DR
NORTH CHARLESTON SC
29406-6500
US

V. Phone/Fax

Practice location:
  • Phone: 843-744-3895
  • Fax: 843-554-1103
Mailing address:
  • Phone: 843-744-3895
  • Fax: 843-554-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number9807
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: