Provider Demographics
NPI:1861468043
Name:WAINER, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:WAINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:ALAN
Other - Last Name:WAINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:95 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3155
Mailing Address - Country:US
Mailing Address - Phone:781-762-1805
Mailing Address - Fax:781-762-2556
Practice Address - Street 1:95 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3155
Practice Address - Country:US
Practice Address - Phone:781-762-1805
Practice Address - Fax:781-762-2556
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30586207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A53783Medicare UPIN