MEDICARE: DR. JOSEPH S WEISMAN MD

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	207W00000X	Ophthalmology Physician	0101048960	VA
2	207WX0109X	Neuro-ophthalmology Physician	0101048960	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	00X723W01	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	298425	OTHER	BC/BS PROVIDER ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	C10500	OTHER	GROUP PTAN

General Provider Information

NPI Number	:	1659324267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH S WEISMAN MD

Provider Business Mailing Address
First Line	:	1225 MAPLE AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-4707
Country	:	US
Telephone Number	:	540-345-2020
Fax Number	:	540-344-0079

Provider Business Practice Location Address
First Line	:	1225 MAPLE AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-4707
Country	:	US
Telephone Number	:	540-345-2020
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/18/2020

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Directions to “ DR. JOSEPH S WEISMAN MD” Practice Location

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