Provider Demographics
NPI:1528094554
Name:WEISBERGER, STEVEN I (DO)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:I
Last Name:WEISBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 SNARE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:JONESPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04649-3139
Mailing Address - Country:US
Mailing Address - Phone:207-497-5614
Mailing Address - Fax:207-497-5554
Practice Address - Street 1:70 SNARE CREEK LN
Practice Address - Street 2:
Practice Address - City:JONESPORT
Practice Address - State:ME
Practice Address - Zip Code:04649-3139
Practice Address - Country:US
Practice Address - Phone:207-497-5614
Practice Address - Fax:207-497-5554
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME257740099Medicaid
MED93049Medicare UPIN
MEMM0292Medicare ID - Type Unspecified