Provider Demographics
NPI:1427053073
Name:WEISMAN, BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4699 MAIN ST
Mailing Address - Street 2:STE 209
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1830
Mailing Address - Country:US
Mailing Address - Phone:203-374-2747
Mailing Address - Fax:203-372-0204
Practice Address - Street 1:4699 MAIN ST
Practice Address - Street 2:STE 209
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1830
Practice Address - Country:US
Practice Address - Phone:203-374-2747
Practice Address - Fax:203-372-0204
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025872174400000X, 207RG0300X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCSP.0012514OtherSTATE CONTROLLED SUBSTANCES
CT125872OtherSTATE LICENSE
CT001258722Medicaid
CT1427053073OtherNPI
CTAW2819095OtherDEA
CT001258722Medicaid
CT110001353Medicare PIN