Provider Demographics
NPI:1457478745
Name:WEINGARTEN, ROSLYN BERNADETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSLYN
Middle Name:BERNADETTE
Last Name:WEINGARTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSLYN
Other - Middle Name:
Other - Last Name:TANNOURY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3144 BEACH VIEW CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3531
Mailing Address - Country:US
Mailing Address - Phone:702-300-5228
Mailing Address - Fax:702-684-7469
Practice Address - Street 1:2001 S RAINBOW BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2990
Practice Address - Country:US
Practice Address - Phone:702-315-4600
Practice Address - Fax:702-315-4607
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1457478745Medicaid
NVFA245YMedicare PIN
NV1457478745Medicaid