Provider Demographics
NPI:1821039405
Name:WEINER, ROBERT MACY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MACY
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:70 CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4057
Mailing Address - Country:US
Mailing Address - Phone:617-232-4525
Mailing Address - Fax:617-232-4525
Practice Address - Street 1:70 CARLTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4057
Practice Address - Country:US
Practice Address - Phone:617-232-4525
Practice Address - Fax:617-232-4525
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA272122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC04583OtherBCBS
B95176Medicare UPIN
MAC04583OtherBCBS