Provider Demographics
NPI:1760578884
Name:WEINER, PAUL RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RUSSELL
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5612 SPRUCE TREE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1626
Mailing Address - Country:US
Mailing Address - Phone:301-564-5880
Mailing Address - Fax:301-564-5889
Practice Address - Street 1:5612 SPRUCE TREE AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1626
Practice Address - Country:US
Practice Address - Phone:301-564-5880
Practice Address - Fax:301-564-5889
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDDOO38334208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics