Provider Demographics
NPI:1649225822
Name:WEINER, RICHARD L (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:WEINER
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 1:362 N BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1148
Mailing Address - Country:US
Mailing Address - Phone:508-350-2350
Mailing Address - Fax:508-350-2318
Practice Address - Street 1:430 PLYMOUTH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HALIFAX
Practice Address - State:MA
Practice Address - Zip Code:02338-1342
Practice Address - Country:US
Practice Address - Phone:781-422-2900
Practice Address - Fax:781-422-2905
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2020505Medicaid
MAJ05010Medicare ID - Type Unspecified
MAB74568Medicare UPIN