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General NPI Number Information
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NPI Number | 1124026406
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Entity Type | Individual
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Provider Name | HERVEY A WEITZMAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 02/09/2010
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Provider Practice Location Address
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Address Line | 175 JEFFERSON ST
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City | FAIRFIELD
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State | CT
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Zip | 06825-1078
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Country | US
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Telephone | 203-365-6473
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Fax | 203-396-1039
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Provider Business Mailing Address
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Address Line | 175 JEFFERSON ST
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City | FAIRFIELD
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State | CT
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Zip | 06825-1078
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Country | US
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Telephone | 203-365-6473
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Fax | 203-396-1039
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 24011
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 24011
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License Number State | CT
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