Provider Demographics
NPI:1851617419
Name:WEINER, ETHAN SAUL (MD)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:SAUL
Last Name:WEINER
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 1:20 CHAPMAN DR
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1001
Mailing Address - Country:US
Mailing Address - Phone:860-691-1661
Mailing Address - Fax:860-760-6216
Practice Address - Street 1:20 CHAPMAN DR
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1001
Practice Address - Country:US
Practice Address - Phone:860-691-1661
Practice Address - Fax:860-760-6216
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025506207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology