Provider Demographics
NPI:1598760464
Name:WEINBERG, ALAN G (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:G
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 1:1320 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3707
Mailing Address - Country:US
Mailing Address - Phone:614-239-8844
Mailing Address - Fax:614-239-8289
Practice Address - Street 1:3120 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3707
Practice Address - Country:US
Practice Address - Phone:614-239-8844
Practice Address - Fax:614-239-8289
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35029550207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0160356Medicaid
OH0160356Medicaid
OH0362701Medicare PIN