Provider Demographics
NPI:1922032689
Name:WEISS, SANDRA A (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:WEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 CHAPMAN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5436
Mailing Address - Country:US
Mailing Address - Phone:302-623-1929
Mailing Address - Fax:302-366-1075
Practice Address - Street 1:252 CHAPMAN ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-1929
Practice Address - Fax:302-366-1075
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.118360207R00000X
DEC1-0009721207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine