Provider Demographics
NPI:1679504062
Name:WEINSTEIN, DAVID JAY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAY
Last Name:WEINSTEIN
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 1:528 W RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5547
Mailing Address - Country:US
Mailing Address - Phone:757-539-4482
Mailing Address - Fax:
Practice Address - Street 1:109 RAILROAD AVENUE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:VA
Practice Address - Zip Code:23888
Practice Address - Country:US
Practice Address - Phone:757-899-3521
Practice Address - Fax:757-899-7104
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101018926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA263206OtherOPTIMA MEDICAID
VA323791OtherANTHEM WMC
VA41033OtherOPTIMA
VA5632081Medicaid
VA323793OtherANTHEM SFM
VA5632081Medicaid
VA323793OtherANTHEM SFM