Provider Demographics
NPI:1518052687
Name:WEINSTEIN, MIRIAM LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:LYNN
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 LAUREL AVE
Mailing Address - Street 2:STE 404
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1879
Mailing Address - Country:US
Mailing Address - Phone:865-331-1266
Mailing Address - Fax:865-331-1274
Practice Address - Street 1:2001 LAUREL AVE STE 404
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1879
Practice Address - Country:US
Practice Address - Phone:865-331-1266
Practice Address - Fax:865-331-1274
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000025597208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3084667Medicaid
3084669Medicare ID - Type Unspecified
TN3084667Medicaid