Basic Information
Provider Information | |||||||||
NPI: | 1538150503 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WEISS | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: | DANIEL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 8 | ||||||||
Address2: | 10 WAYMAN LANE | ||||||||
City: | BAR HARBOR | ||||||||
State: | ME | ||||||||
PostalCode: | 046090008 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2072885081 | ||||||||
FaxNumber: | 2072888449 | ||||||||
Practice Location | |||||||||
Address1: | 10 WAYMAN LN | ||||||||
Address2: |   | ||||||||
City: | BAR HARBOR | ||||||||
State: | ME | ||||||||
PostalCode: | 046091625 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2072885081 | ||||||||
FaxNumber: | 2072888449 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/31/2005 | ||||||||
LastUpdateDate: | 02/13/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 013771 | ME | N |   | Other Service Providers | Specialist |   | 207R00000X | 013771 | ME | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RP1001X | 013771 | ME | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
ID | Type | State | Issuer | Description | 2662639 | 01 | ME | AETNA PCP | OTHER | 037933 | 01 | ME | ANTHEM BC/BS | OTHER | 133070000 | 05 | ME |   | MEDICAID | 2171837 | 01 | ME | AETNA SPECIALIST | OTHER | 290012471 | 01 | ME | RAILROAD MEDICARE PIN | OTHER |