Provider Demographics
NPI:1912978073
Name:WEIN, RICHARD O
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:O
Last Name:WEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WASHINGTON ST # 850
Mailing Address - Street 2:DEPARTMENT OF OTOLARYNGOLOGY-HEAD AND NECK SURGERY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1526
Mailing Address - Country:US
Mailing Address - Phone:617-636-8711
Mailing Address - Fax:617-636-1479
Practice Address - Street 1:750 WASHINGTON ST # 850
Practice Address - Street 2:DEPARTMENT OF OTOLARYNGOLOGY-HEAD AND NECK SURGERY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-8711
Practice Address - Fax:617-636-1479
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD16864207Y00000X
MA227904207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08900258Medicaid
MS0400000191Medicare ID - Type Unspecified
MS08900258Medicaid