Provider Demographics
NPI:1558364604
Name:WEINBERG, MARC S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:S
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARC
Other - Middle Name:S
Other - Last Name:WEINBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:82 TALBOT WAY
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-2802
Mailing Address - Country:US
Mailing Address - Phone:508-399-8332
Mailing Address - Fax:615-234-2460
Practice Address - Street 1:1 RANDALL SQ STE 304
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2773
Practice Address - Country:US
Practice Address - Phone:401-228-3000
Practice Address - Fax:401-649-4222
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43058207RN0300X
RIMD05402207RN0300X
RIRI5402174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7000252Medicaid
RI7000252Medicaid
RI007000252Medicare ID - Type Unspecified