Provider Demographics
NPI:1427019033
Name:WEINBAUM, RICHARD S (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:WEINBAUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:1814 WESTCHESTER DR
Practice Address - Street 2:STE 300
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7369
Practice Address - Country:US
Practice Address - Phone:336-802-2055
Practice Address - Fax:336-802-2056
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908189Medicaid
NC480031935OtherRR MEDICARE
NC243057EMedicare ID - Type Unspecified
NC243057FMedicare PIN
NC8908189Medicaid