Provider Demographics
NPI:1144332859
Name:STUART MARTIN WEISMAN, MD, IN
Entity type:Organization
Organization Name:STUART MARTIN WEISMAN, MD, IN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:WEISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-322-2900
Mailing Address - Street 1:900 WELCH RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1805
Mailing Address - Country:US
Mailing Address - Phone:650-322-2900
Mailing Address - Fax:650-322-2904
Practice Address - Street 1:900 WELCH RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1805
Practice Address - Country:US
Practice Address - Phone:650-322-2900
Practice Address - Fax:650-322-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57035261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ30093ZMedicare ID - Type Unspecified
CAZZZ24164ZMedicare ID - Type UnspecifiedPALO ALTO PROVIDER NUMBER
CAA53222Medicare UPIN