Provider Demographics
NPI:1740259498
Name:JAMES I. WEINBERG, DO
Entity type:Organization
Organization Name:JAMES I. WEINBERG, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DINAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-449-9666
Mailing Address - Street 1:850 W CHESTER PIKE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4439
Mailing Address - Country:US
Mailing Address - Phone:610-449-9666
Mailing Address - Fax:610-449-9822
Practice Address - Street 1:850 W CHESTER PIKE
Practice Address - Street 2:SUITE 301
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4439
Practice Address - Country:US
Practice Address - Phone:610-449-9666
Practice Address - Fax:610-449-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA041812Medicare ID - Type Unspecified
D66401Medicare UPIN