Provider Demographics
NPI:1770647992
Name:WEINSTEIN, LAWRENCE I (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:I
Last Name:WEINSTEIN
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 1:1500 CONCORD TERRACE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2823
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:954-858-0404
Practice Address - Street 1:980 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 620
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-255-2057
Practice Address - Fax:404-256-4238
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47551207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00842311AMedicaid
GA702250OtherBCBS PIN NUMBER
GA00842311BMedicaid
GA4585000OtherAETNA PROV NUMBER
GA00842311AMedicaid
GA4585000OtherAETNA PROV NUMBER