Provider Demographics
NPI:1437188174
Name:WEINTRAUB, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:WEINTRAUB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64515
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4515
Mailing Address - Country:US
Mailing Address - Phone:410-328-5881
Mailing Address - Fax:
Practice Address - Street 1:701 W PRATT ST FL 4
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:410-328-5881
Practice Address - Fax:410-328-8552
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035607207P00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD079121100Medicaid
MDC007Medicare PIN
MD110148611Medicare PIN
H705Medicare PIN
MDJG52Medicare PIN
MD079121100Medicaid
MDP110148611Medicare PIN