Provider Demographics
NPI:1245332477
Name:WEINSTEIN, FREDERICK GORDON (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:GORDON
Last Name:WEINSTEIN
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 1:110 WEST RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2316
Mailing Address - Country:US
Mailing Address - Phone:443-418-5999
Mailing Address - Fax:410-561-5598
Practice Address - Street 1:110 WEST RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2316
Practice Address - Country:US
Practice Address - Phone:443-418-5999
Practice Address - Fax:410-561-5598
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD29576207VE0102X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCE1630001OtherBLUE CHOICE
MD523284OtherAETNA HMO
MD8863OtherBC/BS OF MARYLAND
MDE163OtherBC/NS OF DC
MDE163OtherBC/NS OF DC
MD8863Medicare ID - Type Unspecified