Provider Demographics
NPI:1528022621
Name:WEINREB, WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:WEINREB
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 1:21 MAIN STREET
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-3103
Mailing Address - Country:US
Mailing Address - Phone:978-276-0100
Mailing Address - Fax:978-276-0041
Practice Address - Street 1:21 MAIN ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-5001
Practice Address - Country:US
Practice Address - Phone:978-276-0100
Practice Address - Fax:978-276-0041
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA57832Medicare UPIN
MAJ04496Medicare ID - Type Unspecified