MEDICARE: THE VILLAGE DOCTOR

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1568819522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VILLAGE DOCTOR

Provider Business Mailing Address
First Line	:	2979 WOODSIDE RD
Second Line	:
City	:	WOODSIDE
State	:	CA
Zip	:	94062-2443
Country	:	US
Telephone Number	:	650-851-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2979 WOODSIDE RD
Second Line	:
City	:	WOODSIDE
State	:	CA
Zip	:	94062-2443
Country	:	US
Telephone Number	:	650-851-4747
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ERIC LEONARD WEISS
Credential	:	M.D.
Telephone Number	:	650-851-4747

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	02/26/2025

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Directions to “THE VILLAGE DOCTOR ” Practice Location

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