Provider Demographics
NPI:1649291113
Name:WEINSTEIN, LAWRENCE MARK (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MARK
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 1:9868 S STATE ROAD 7
Mailing Address - Street 2:STE 335
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-4476
Mailing Address - Country:US
Mailing Address - Phone:561-742-7991
Mailing Address - Fax:
Practice Address - Street 1:9868 S STATE ROAD 7
Practice Address - Street 2:STE 335
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-4476
Practice Address - Country:US
Practice Address - Phone:561-200-3583
Practice Address - Fax:561-739-8715
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83194174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6336XMedicare PIN
FLB58768Medicare UPIN