Provider Demographics
NPI:1467663690
Name:LARRY A WEINRAUCH MD PC
Entity Type:Organization
Organization Name:LARRY A WEINRAUCH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEINRAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-923-0800
Mailing Address - Street 1:521 MOUNT AUBURN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4191
Mailing Address - Country:US
Mailing Address - Phone:617-923-0800
Mailing Address - Fax:617-926-5665
Practice Address - Street 1:521 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4191
Practice Address - Country:US
Practice Address - Phone:617-923-0800
Practice Address - Fax:617-926-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35819207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA035819OtherMASS LICENSE
MA2033704Medicaid
MA2033704Medicaid
=========OtherEMPLOYER ID
MAM13372Medicare ID - Type Unspecified
MAB34466Medicare ID - Type Unspecified