Provider Demographics
NPI:1407899073
Name:WEINSTEIN, MARK H (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:WEINSTEIN
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 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5238
Mailing Address - Country:US
Mailing Address - Phone:203-624-0673
Mailing Address - Fax:203-907-4593
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:#407
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-624-0673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018620208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTNHS110OtherOXFORD
CT0Q0135OtherHEALTHNET ID
CT186200OtherCTCARE
CT010018620CT01OtherANTHEM ID
CT0Q0135OtherHEALTHNET ID