Provider Demographics
NPI:1730146036
Name:WEITBERG, ALAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:B
Last Name:WEITBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:820 HARRISON AVE
Mailing Address - Street 2:FGH 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2905
Mailing Address - Country:US
Mailing Address - Phone:617-638-7523
Mailing Address - Fax:617-414-1831
Practice Address - Street 1:820 HARRISON AVE
Practice Address - Street 2:FGH 1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2905
Practice Address - Country:US
Practice Address - Phone:617-638-7523
Practice Address - Fax:617-414-1831
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI05313207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9006264Medicaid
RI9006264Medicaid
RI007057470Medicare ID - Type Unspecified