Provider Demographics
NPI:1013083526
Name:WEINSTEIN, MARTIN (MPT)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 FRANKLIN AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1263
Mailing Address - Country:US
Mailing Address - Phone:410-641-2900
Mailing Address - Fax:410-641-2914
Practice Address - Street 1:314 FRANKLIN AVE STE 405
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1263
Practice Address - Country:US
Practice Address - Phone:410-641-2900
Practice Address - Fax:410-641-2914
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402788400Medicaid