Provider Demographics
NPI:1700874450
Name:WEINER, JAMES SHERMAN (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SHERMAN
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:830 OAK ST
Mailing Address - Street 2:STE 200W
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1168
Mailing Address - Country:US
Mailing Address - Phone:508-586-7334
Mailing Address - Fax:508-583-7599
Practice Address - Street 1:830 OAK ST
Practice Address - Street 2:STE 200W
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1168
Practice Address - Country:US
Practice Address - Phone:508-586-7334
Practice Address - Fax:508-583-7599
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA37946208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
037946OtherTUFTS
28872OtherFALLON
BW10077101OtherCIGNA
0092111OtherAETNA
30191OtherBMC HEALTHNET
MA2033526Medicaid
M08929OtherBLUE CROSS
20049OtherHPHC
MA2033526Medicaid