Provider Demographics
NPI:1841390101
Name:WEINSTEIN, MAYER HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYER
Middle Name:HOWARD
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:HOWARD
Other - Last Name:WEINSTIEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1220 SW MORRISON ST
Mailing Address - Street 2:#525
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2224
Mailing Address - Country:US
Mailing Address - Phone:503-223-6360
Mailing Address - Fax:503-497-1257
Practice Address - Street 1:1220 SW MORRISON ST
Practice Address - Street 2:#525
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2224
Practice Address - Country:US
Practice Address - Phone:503-223-6360
Practice Address - Fax:503-497-1257
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD090352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E20618Medicare UPIN
0000BHFWKMedicare ID - Type Unspecified