Provider Demographics
NPI:1205859931
Name:WEINER, LOUIS MARC (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:MARC
Last Name:WEINER
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 1:3970 RESERVOIR RD NW
Mailing Address - Street 2:LCCC GEORGETOWN UNIVERSITY MEDICAL CENTER ROOM E501
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2126
Mailing Address - Country:US
Mailing Address - Phone:202-687-2110
Mailing Address - Fax:202-687-6402
Practice Address - Street 1:3970 RESERVOIR RD NW
Practice Address - Street 2:LCCC GEORGETOWN UNIVERSITY MEDICAL CENTER ROOM E501
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2126
Practice Address - Country:US
Practice Address - Phone:202-687-2110
Practice Address - Fax:202-687-6402
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031312E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC30750Medicare UPIN
DC158629YTFMedicare PIN