Provider Demographics
NPI:1336218577
Name:WEIN, MARTIN FREDERICK (EDD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:FREDERICK
Last Name:WEIN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 WICKLOW LOOP
Mailing Address - Street 2:MARTIN WEIN EDD
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236
Mailing Address - Country:US
Mailing Address - Phone:804-745-4078
Mailing Address - Fax:
Practice Address - Street 1:2602 WICKLOW LOOP
Practice Address - Street 2:MARTIN WEIN EDD
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236
Practice Address - Country:US
Practice Address - Phone:804-745-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002334103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA140664OtherANTHEM
VA2031483OtherCIGNA
VA7702779Medicaid