Provider Demographics
NPI:1831266733
Name:WEISMAN, DALE M (MD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:M
Last Name:WEISMAN
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 1:401 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5528
Mailing Address - Country:US
Mailing Address - Phone:610-867-0772
Mailing Address - Fax:610-954-5333
Practice Address - Street 1:401 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5528
Practice Address - Country:US
Practice Address - Phone:610-867-0772
Practice Address - Fax:610-954-5333
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037834-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
049609Medicare ID - Type Unspecified
B40494Medicare UPIN