Provider Demographics
NPI:1457454316
Name:WEBER, MARILYN P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:P
Last Name:WEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VETERANS DR
Mailing Address - Street 2:#117
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-467-3556
Mailing Address - Fax:612-727-5642
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:#117
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-3556
Practice Address - Fax:612-727-5642
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN33415208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN33415OtherMEDICAL LICENSE