Provider Demographics
NPI:1972014785
Name:PETER L. WEINGARTEN MD PC
Entity Type:Organization
Organization Name:PETER L. WEINGARTEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL/PERSONAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAYLA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:NCMA
Authorized Official - Phone:303-671-2122
Mailing Address - Street 1:1411 S POTOMAC ST STE 400
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4540
Mailing Address - Country:US
Mailing Address - Phone:303-671-2122
Mailing Address - Fax:303-671-2122
Practice Address - Street 1:1411 S POTOMAC ST STE 400
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4540
Practice Address - Country:US
Practice Address - Phone:303-671-2122
Practice Address - Fax:303-671-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022177261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COATN54776Medicaid