Provider Demographics
NPI:1710955463
Name:WEINBERG, JAMES I (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:I
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W CHESTER PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4500
Mailing Address - Country:US
Mailing Address - Phone:610-449-9666
Mailing Address - Fax:610-449-9822
Practice Address - Street 1:525 W CHESTER PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4500
Practice Address - Country:US
Practice Address - Phone:610-449-9666
Practice Address - Fax:610-449-9822
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-002583-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D66401Medicare UPIN
D66401Medicare UPIN
PA041812Medicare ID - Type Unspecified