Healthcare Provider Details

I. General information

NPI: 1013023902
Provider Name (Legal Business Name): DAVID WEISSMAN M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 STADIUM DRIVE
MORGANTOWN WV
26506
US

IV. Provider business mailing address

P. O. BOX 897
MORGANTOWN WV
26507-0897
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4800
  • Fax: 304-293-6963
Mailing address:
  • Phone: 304-293-7401
  • Fax: 304-293-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number16993
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number16993
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: