Basic Information
| Provider Information | |||||||||
| NPI: | 1750589214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEISS | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13306 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240323306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403450289 | ||||||||
| FaxNumber: | 5403459569 | ||||||||
| Practice Location | |||||||||
| Address1: | 12200 WARWICK BLVD STE 290 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236012344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575345454 | ||||||||
| FaxNumber: | 7575345491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101244049 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LC0200X | 0101244049 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207LC0200X | TP221 | KY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine |
No ID Information.