Provider Demographics
NPI:1780759142
Name:WEINBAUM PSYCHIATRIC SERVICES
Entity type:Organization
Organization Name:WEINBAUM PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEINBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-629-0034
Mailing Address - Street 1:604 S COIT ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5223
Mailing Address - Country:US
Mailing Address - Phone:843-629-0034
Mailing Address - Fax:843-629-9192
Practice Address - Street 1:604 S COIT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5223
Practice Address - Country:US
Practice Address - Phone:843-629-0034
Practice Address - Fax:843-629-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19584SC2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC189903OtherAPS
SC195844Medicaid
SC195844Medicaid
SC=========OtherBCBS