Provider Demographics
NPI:1336307305
Name:WEINE, DOUGLAS MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MATTHEW
Last Name:WEINE
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 1:365 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2150
Mailing Address - Country:US
Mailing Address - Phone:732-842-4294
Mailing Address - Fax:732-548-7408
Practice Address - Street 1:365 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2150
Practice Address - Country:US
Practice Address - Phone:732-842-4294
Practice Address - Fax:732-548-7408
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238902207RG0100X
NJ25MA08720600207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology