Provider Demographics
NPI:1780874487
Name:WEINER, JUSTIN B (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:B
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:765 N HAMILTON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8703
Practice Address - Country:US
Practice Address - Phone:614-533-5500
Practice Address - Fax:614-533-5059
Is Sole Proprietor?:No
Enumeration Date:2007-07-29
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.121922207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3001386Medicaid
TN4182435OtherBCBST
KY7100036390OtherKENTUCKY MEDICAID
TN4182435OtherBCBST
3001386Medicare PIN