Provider Demographics
NPI:1902072861
Name:WEISS, GREGORY MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MARC
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 1:859 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-3259
Mailing Address - Country:US
Mailing Address - Phone:919-828-9937
Mailing Address - Fax:919-828-4287
Practice Address - Street 1:859 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-3259
Practice Address - Country:US
Practice Address - Phone:919-828-9937
Practice Address - Fax:919-828-4287
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012656762084P0800X
NC128-1622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry