Provider Demographics
NPI:1952511313
Name:WEINSTEIN, BRUCE DOUGLAS (DPM)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:DOUGLAS
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 W RACE ST
Mailing Address - Street 2:
Mailing Address - City:CATASAUQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18032-1992
Mailing Address - Country:US
Mailing Address - Phone:610-264-2244
Mailing Address - Fax:
Practice Address - Street 1:18 W RACE ST
Practice Address - Street 2:
Practice Address - City:CATASAUQUA
Practice Address - State:PA
Practice Address - Zip Code:18032-1992
Practice Address - Country:US
Practice Address - Phone:610-264-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002918L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1041607Medicaid
PAT72547Medicare UPIN
PA1041607Medicaid