Individual
DR. BENJAMIN WEISMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4699 MAIN ST, STE 209, BRIDGEPORT, CT 06606-1830
(203) 374-2747
(203) 372-0204
Mailing address
4699 MAIN ST, STE 209, BRIDGEPORT, CT 06606-1830
(203) 374-2747
(203) 372-0204
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
025872
CT
207R00000X
Internal Medicine Physician
Primary
025872
CT
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
025872
CT
207RP1001X
Pulmonary Disease Physician
025872
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001258722
—
CT
01
—
125872
STATE LICENSE
CT
01
—
1427053073
NPI
CT
01
—
CSP.0012514
STATE CONTROLLED SUBSTANCES
CT
Enumeration date
06/20/2005
Last updated
03/07/2023
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