MEDICARE: DR. SUSAN WEISBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME0055048	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073513255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN WEISBERG M.D.

Provider Business Mailing Address
First Line	:	1400 DOWELL SPRINGS BLVD
Second Line	:	SUITE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2456
Country	:	US
Telephone Number	:	865-584-0291
Fax Number	:	865-584-4426

Provider Business Practice Location Address
First Line	:	1400 DOWELL SPRINGS BLVD
Second Line	:	SUITE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2456
Country	:	US
Telephone Number	:	865-584-0291
Fax Number	:	865-584-4426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	03/02/2010

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Directions to “ DR. SUSAN WEISBERG M.D.” Practice Location

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