Provider Demographics
NPI:1255476610
Name:WEINBERG, AVRAM (DC)
Entity Type:Individual
Prefix:
First Name:AVRAM
Middle Name:
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5268 NICHOLSON LN
Mailing Address - Street 2:SUITE S
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1009
Mailing Address - Country:US
Mailing Address - Phone:301-231-5055
Mailing Address - Fax:301-231-7217
Practice Address - Street 1:5268 NICHOLSON LN
Practice Address - Street 2:SUITE S
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1009
Practice Address - Country:US
Practice Address - Phone:301-231-5055
Practice Address - Fax:301-231-7217
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1230PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD120822Medicare PIN