Provider Demographics
NPI:1073583944
Name:WEINTRAUB GERIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:WEINTRAUB GERIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:WEINRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-916-1066
Mailing Address - Street 1:31 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1445
Mailing Address - Country:US
Mailing Address - Phone:617-916-1066
Mailing Address - Fax:
Practice Address - Street 1:804 E 7TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-4346
Practice Address - Country:US
Practice Address - Phone:617-268-8968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9735640Medicaid
MADC3209OtherRR MEDICARE
MADC3209OtherRR MEDICARE