Provider Demographics
NPI:1487711537
Name:WEISS, BURTON (MD)
Entity type:Individual
Prefix:
First Name:BURTON
Middle Name:
Last Name:WEISS
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 1:1601 WALNUT ST
Mailing Address - Street 2:SUITE 1422
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2944
Mailing Address - Country:US
Mailing Address - Phone:215-569-8736
Mailing Address - Fax:215-569-1460
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:SUITE 1422
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:215-569-8736
Practice Address - Fax:215-569-1460
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015409E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6108105Medicaid
PAWE135889 0654283 01Medicaid
PA954952OtherUS HEALTHCARE
PA954952OtherUS HEALTHCARE
PAWE135889 0654283 01Medicaid