Provider Demographics
NPI:1447225099
Name:WEINRAUB, BRUCE M (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:M
Last Name:WEINRAUB
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 1:76 CARLON DR
Mailing Address - Street 2:#C
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2373
Mailing Address - Country:US
Mailing Address - Phone:413-585-0700
Mailing Address - Fax:413-586-7017
Practice Address - Street 1:76 CARLON DR
Practice Address - Street 2:#C
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2373
Practice Address - Country:US
Practice Address - Phone:413-585-0700
Practice Address - Fax:413-586-7017
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA66151OtherHARVARD PILGRIM
MA1011206OtherAETNA
MAJ04772OtherBCBSMA
MA000000007703OtherBMC
MA549801OtherCONNECTICARE
MA6198678Medicaid
MA754980OtherTUFTS
MA1024110OtherCIGNA
MA17612OtherHEALTH NEW ENGLAND
MA000000007703OtherBMC
J04772Medicare ID - Type Unspecified