Provider Demographics
NPI:1760456057
Name:WEINER, ALAN B (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:B
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1214
Mailing Address - Country:US
Mailing Address - Phone:508-403-7877
Mailing Address - Fax:
Practice Address - Street 1:401 KINGS HWY S
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2500
Practice Address - Country:US
Practice Address - Phone:856-475-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11214200207QA0401X
MA73864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-3194547OtherNORTHEAST HEALTH DIRECT
MAJ11185OtherBCBSMA
MA000000007921OtherBMC
MA04-3194547OtherCONSOLIDATED
MA71794OtherHARVARD PILGRIM
MA04-3194547OtherPLAN VISTA
MA2358647OtherAETNA
MA04-3194547OtherGREAT-WEST
MA04-3194547OtherNORTHEAST HEALTHCARE ALLI
MA1024160OtherCIGNA
MA04-3194547OtherUNICARE/GIC
MA04-3194547OtherPRIVATE HEALTHCARE SYSTEM
MA04-3194547OtherNORTH AMERICAN PREFERRED
MA073864OtherTUFTS
MA3077225Medicaid
MA738641OtherCONNECTICARE
MA20409OtherHEALTH NEW ENGLAND
B98844Medicare UPIN
MA04-3194547OtherGREAT-WEST