Provider Demographics
NPI:1265507628
Name:WEINBAUM, MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:WEINBAUM
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 1:3002 SE 1ST AVE
Mailing Address - Street 2:BUILDING 100
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0477
Mailing Address - Country:US
Mailing Address - Phone:352-732-0450
Mailing Address - Fax:
Practice Address - Street 1:3002 SE 1ST AVE
Practice Address - Street 2:BUILDING 100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0477
Practice Address - Country:US
Practice Address - Phone:352-732-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19584SC2084P0800X
IN01029010C2084P0802X
FLME531202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100331450Medicaid
SC195844Medicaid
SC189903OtherAPS
SC327877Medicaid
SC3344Medicare UPIN
SCD901650281Medicare ID - Type Unspecified
ININ1663062Medicare PIN
SC195844Medicaid