Provider Demographics
NPI:1568449031
Name:WEISBERG, NOAH KAWIKA (MD)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:KAWIKA
Last Name:WEISBERG
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 1:103 REMO PL
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1740
Mailing Address - Country:US
Mailing Address - Phone:615-352-9798
Mailing Address - Fax:
Practice Address - Street 1:4601 MILITARY TRL
Practice Address - Street 2:SUITE 203
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4834
Practice Address - Country:US
Practice Address - Phone:561-775-6011
Practice Address - Fax:561-775-6044
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85020207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H63524Medicare UPIN
17067Medicare ID - Type Unspecified