Provider Demographics
NPI:1306858113
Name:WEINRAUCH, LARRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:A
Last Name:WEINRAUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:521 MOUNT AUBURN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4191
Mailing Address - Country:US
Mailing Address - Phone:617-923-0800
Mailing Address - Fax:617-926-5665
Practice Address - Street 1:521 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4191
Practice Address - Country:US
Practice Address - Phone:617-923-0800
Practice Address - Fax:617-926-5665
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35819207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2257836OtherAETNA
MA3235OtherHARVARD PILGRIM
MAM13372OtherBLUE CROSS BLUE SHIELD
MA035819OtherTUFTS
MA04-2726136OtherCOST CARE
MA2033704Medicaid
MAM13372OtherBLUE CROSS BLUE SHIELD
MAM13372Medicare ID - Type Unspecified
MA060029513Medicare ID - Type UnspecifiedRAILROAD MEDICARE