Provider Demographics
NPI:1033130430
Name:WEINROTH, STEPHEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:WEINROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11211 WAPLES MILL ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7406
Mailing Address - Country:US
Mailing Address - Phone:703-246-9560
Mailing Address - Fax:703-246-9564
Practice Address - Street 1:11211 WAPLES MILL ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7406
Practice Address - Country:US
Practice Address - Phone:703-246-9560
Practice Address - Fax:703-246-9564
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045492207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006091423Medicaid
VAF80200Medicare UPIN
VA769827-I58Medicare ID - Type Unspecified