Healthcare Provider Details

I. General information

NPI: 1750589214
Provider Name (Legal Business Name): GREGORY M. WEISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 WARWICK BLVD STE 290
NEWPORT NEWS VA
23601-2344
US

IV. Provider business mailing address

PO BOX 13306
ROANOKE VA
24032-3306
US

V. Phone/Fax

Practice location:
  • Phone: 757-534-5454
  • Fax: 757-534-5491
Mailing address:
  • Phone: 540-345-0289
  • Fax: 540-345-9569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101244049
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number0101244049
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberTP221
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: