Provider Demographics
NPI:1417931684
Name:WEINBERGER, RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:WEINBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KELLY ST
Mailing Address - Street 2:STE 7
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1627
Mailing Address - Country:US
Mailing Address - Phone:570-876-5826
Mailing Address - Fax:570-876-0141
Practice Address - Street 1:4 KELLY ST
Practice Address - Street 2:SUITE 7
Practice Address - City:ARCHBALD
Practice Address - State:PA
Practice Address - Zip Code:18403-1627
Practice Address - Country:US
Practice Address - Phone:570-876-5826
Practice Address - Fax:570-876-0141
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004901L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001000300Medicaid
PA423590NW4Medicare ID - Type Unspecified
PAP00086836Medicare PIN
PAB41571Medicare UPIN