Provider Demographics
NPI:1720013303
Name:WEINBERG, NOLAN L (MD)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:L
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 1:7825 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2608
Mailing Address - Country:US
Mailing Address - Phone:513-561-4811
Mailing Address - Fax:513-561-2730
Practice Address - Street 1:7825 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2608
Practice Address - Country:US
Practice Address - Phone:513-561-4811
Practice Address - Fax:513-561-2730
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35040632Medicaid
OHA76273Medicare UPIN
OH35040632Medicaid