Provider Demographics
NPI:1891763710
Name:WEINBERG, ELLEN ADLER (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:ADLER
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 HARRISON AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2905
Mailing Address - Country:US
Mailing Address - Phone:617-638-8124
Mailing Address - Fax:617-638-6424
Practice Address - Street 1:720 HARRISON AVE
Practice Address - Street 2:DOB 503
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2371
Practice Address - Country:US
Practice Address - Phone:617-414-5405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075774A207Y00000X
MA243827207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040011619OtherRAILROAD MEDICARE
MA110086810AMedicaid
CA8673OtherRAILROAD MEDICARE
IN259370087Medicare PIN
040011619OtherRAILROAD MEDICARE