Provider Demographics
NPI:1376562652
Name:WEINTRAUB, RICHARD P (NP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:WEINTRAUB
Suffix:
Gender:M
Credentials:NP
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Other - Last Name:
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Mailing Address - Street 1:75 MOUNT AUBURN ST
Mailing Address - Street 2:HARVARD UNIVERSITY HEALTH SERVICE
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4960
Mailing Address - Country:US
Mailing Address - Phone:617-495-6455
Mailing Address - Fax:617-495-8079
Practice Address - Street 1:33 HARVARD WAY
Practice Address - Street 2:HARVARD UNIVERSITY HEALTH SERVICE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02163-1011
Practice Address - Country:US
Practice Address - Phone:617-495-6455
Practice Address - Fax:617-495-8079
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA252018363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ51995Medicare UPIN
MAMX9733Medicare PIN