Provider Demographics
NPI:1306865191
Name:WEINER, PERRY R (DO)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:R
Last Name:WEINER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 CRESCENT DR FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19112-1016
Mailing Address - Country:US
Mailing Address - Phone:215-503-7124
Mailing Address - Fax:215-503-3191
Practice Address - Street 1:3 CRESCENT DR FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1016
Practice Address - Country:US
Practice Address - Phone:215-503-7124
Practice Address - Fax:215-503-3191
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-004988-L208600000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000934330Medicaid