Provider Demographics
NPI:1972721157
Name:LEWIS R. WEINER, M.D., INC.
Entity Type:Organization
Organization Name:LEWIS R. WEINER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-369-7070
Mailing Address - Street 1:1 DAVOL SQ
Mailing Address - Street 2:#304
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4755
Mailing Address - Country:US
Mailing Address - Phone:401-369-7070
Mailing Address - Fax:401-369-7080
Practice Address - Street 1:1 DAVOL SQ
Practice Address - Street 2:#304
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4755
Practice Address - Country:US
Practice Address - Phone:401-369-7070
Practice Address - Fax:401-369-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI07384261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9006564Medicaid
RID87374Medicare UPIN