Provider Demographics
NPI:1912094061
Name:WEINER, NEIL (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:WEINER
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 1:155 S MADISON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3011
Mailing Address - Country:US
Mailing Address - Phone:720-638-6400
Mailing Address - Fax:303-355-5310
Practice Address - Street 1:155 S MADISON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3011
Practice Address - Country:US
Practice Address - Phone:720-638-6400
Practice Address - Fax:303-355-5310
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO269952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01269950Medicaid
COD28891Medicare UPIN
CO01269950Medicaid