Provider Demographics
NPI:1073549077
Name:WEINSTEIN, RICHARD I (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:I
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15225 SHADY GROVE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3254
Mailing Address - Country:US
Mailing Address - Phone:301-670-3000
Mailing Address - Fax:240-632-0164
Practice Address - Street 1:15225 SHADY GROVE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3254
Practice Address - Country:US
Practice Address - Phone:301-670-3000
Practice Address - Fax:240-632-0164
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042777207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD149701400Medicaid
MD689522C83Medicare PIN
MDG03312Medicare UPIN