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NPI Code Detail

MEDICARE: DR. FREDERICK ETHAN WEISS MD

MEDICARE: DR. FREDERICK ETHAN WEISS 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
1207LP2900XPain Medicine (Anesthesiology) PhysicianME123132FL
2208VP0000XPain Medicine PhysicianME123132FL
32085N0700XNeuroradiology PhysicianME123132FL
42085R0202XDiagnostic Radiology PhysicianMD448028PA
52085R0202XDiagnostic Radiology PhysicianETL7045MA
6390200000XStudent in an Organized Health Care Education/Training Program
72085R0202XDiagnostic Radiology PhysicianME155139FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871760538
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FREDERICK ETHAN WEISS MD
Provider Business Mailing Address
First Line : 960 MASSACHUSETTS AVE
Second Line : FLR 2
City : BOSTON
State : MA
Zip : 02118
Country : US
Telephone Number : 617-414-5405
Fax Number : 617-414-6031
Provider Business Practice Location Address
First Line : 701 W PLYMOUTH AVE
Second Line :
City : DELAND
State : FL
Zip : 32720-3236
Country : US
Telephone Number : 386-943-3160
Fax Number : 317-705-5047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2008
Last Update Date : 12/16/2025

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