Provider Demographics
NPI:1497744163
Name:WEINBERG, DAVID H (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:WEINBERG
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 1:736 CAMBRIDGE ST.
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-789-2380
Mailing Address - Fax:617-789-5177
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:CCP 8 NEUROLOGY
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-2380
Practice Address - Fax:617-789-5177
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA494582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6184049Medicaid
MA6184049Medicaid
B74207Medicare UPIN