MEDICARE: GARY A. WEISSBERG, M.D., INC.

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1770874554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY A. WEISSBERG, M.D., INC.

Provider Business Mailing Address
First Line	:	401 W A ST STE 2350
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-7921
Country	:	US
Telephone Number	:	619-232-0905
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 W A ST STE 2350
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-7921
Country	:	US
Telephone Number	:	619-232-0905
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY ALAN WEISSBERG
Credential	:	MD
Telephone Number	:	619-232-0905

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	04/27/2011

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