Individual provider Active NPI

Hervey A Weitzman, MD

  • Hematology & Oncology Physician
  • Fairfield, CT
National Provider Identifier
1124026406
Registry record updated Feb 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
24011 Issued in CT
Practice address
175 Jefferson St
Fairfield, CT 06825-1078
Phone
(203) 365-6473
Fax
(203) 396-1039
NPI assigned
Jul 12, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 9, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 24011 CT
Hematology & Oncology Physician 207RH0003X 24011 CT Primary

Addresses

Primary practice location

175 Jefferson St
Fairfield, CT 06825-1078

Mailing address

175 Jefferson St
Fairfield, CT 06825-1078
Phone (203) 365-6473

Other identifiers 1

IdentifierTypeStateIssuer
001138940MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040422001167 CT Practitioner - Internal Medicine 8224024492 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
24011CTMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Mar 22, 2021 Accepting new patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Mar 22, 2021 Accepting new patients

Locations

4200 Park Ave
Bridgeport, CT 06604
Phone (203) 365-6400

4699 Main St
Ste 213
Bridgeport, CT 06606
Phone (203) 262-1626

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265673600000",
    "number": "1124026406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 JEFFERSON ST",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068251078",
            "telephone_number": "203-365-6473",
            "fax_number": "203-396-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 JEFFERSON ST",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068251078",
            "telephone_number": "203-365-6473",
            "fax_number": "203-396-1039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEITZMAN",
        "first_name": "HERVEY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2010-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "24011",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CT",
            "license": "24011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001138940",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

Verify at the official NPI Registry.