Provider Demographics
NPI:1982653671
Name:WEINER, BRIAN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CHARLES
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:3 RICHLAND MEDICAL PARK DR STE 120
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6850
Practice Address - Country:US
Practice Address - Phone:803-434-8866
Practice Address - Fax:803-933-3049
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04822100207RG0100X
FLME126389207RG0100X
SC88567207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA04822100OtherNJ MEDICAL LICENSE
MDD30036OtherMD MEDICAL LICENSE
FL016610900Medicaid
NJ0496201Medicaid
NY157833OtherNY MEDICAL LICENSE
NJD06118600OtherNJ CDS REGISTRATION
NJD06118600OtherNJ CDS REGISTRATION
NJD06118600OtherNJ CDS REGISTRATION
NY157833OtherNY MEDICAL LICENSE
FL016610900Medicaid