Provider Demographics
NPI:1003228198
Name:GARY WEINBERGER MD PSC
Entity Type:Organization
Organization Name:GARY WEINBERGER MD PSC
Other - Org Name:NICHOLASVILLE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WEINBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-881-0533
Mailing Address - Street 1:610 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1026
Mailing Address - Country:US
Mailing Address - Phone:859-881-0533
Mailing Address - Fax:859-881-0566
Practice Address - Street 1:610 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1026
Practice Address - Country:US
Practice Address - Phone:859-881-0533
Practice Address - Fax:859-881-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33102208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty