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NPI Code Detail

MEDICARE: MARK L WEISSMAN M.D.

MEDICARE: MARK L WEISSMAN 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
1207RN0300XNephrology PhysicianG55308CA

General Provider Information

NPI Number : 1871654384
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK L WEISSMAN M.D.
Provider Business Mailing Address
First Line : 23388 MULHOLLAND DR
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91364-2733
Country : US
Telephone Number : 818-876-1636
Fax Number : 818-876-1516
Provider Business Practice Location Address
First Line : 4323 W RIVERSIDE DR
Second Line :
City : BURBANK
State : CA
Zip : 91505-4044
Country : US
Telephone Number : 818-295-3379
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2006
Last Update Date : 07/08/2007

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